RESUMEN
【Objective】 To investigate the expressions of P53 and Ki-67 in prostate cancer (PCa)and to explore their correlation with the clinicopathological characteristics. 【Methods】 The expressions of P53 and Ki-67 in 90 PCa patients were detected with immunohistochemistry. Patients’ age, preoperative prostate-specific antigen (PSA) level, postoperative Gleason score, pathological stage, and invasion of neurovascular cancer embolus of all patients were recorded. The relationship of P53 expression with the above indexes was evaluated. 【Results】 The positive rates of P53 and Ki-67 were 27.8% (25/90) and 46.7% (42/90), respectively. The positive rate of P53 in pT2 and pT3-T4 stage groups were 19.7% (13/66) and 50.0% (12/24) (P=0.005), and the positive rate of Ki-67 were 36.4% (24/66) and 75.0% (18/24) (P=0.001), respectively. The positive rate of Ki-67 in Gleason score ≤6, ≤7 and ≥8 groups were 30.4%, 53.8% and 66.7%, respectively, with statistical difference. Positive expression of P53 was related to Ki-67 expression, but not to patients’ age, preoperative PSA level, postoperative Gleason score and nerve and invasion of neurovascular cancer embolus. 【Conclusion】 P53 expression is related to tumor stage and Ki-67, while Ki-67 expression is associated with tumor stage ang grade.
RESUMEN
【Objective】 To reduce the misdiagnosis rate by analyzing the clinical data of patients with primary upper tract urothelial carcinoma (UTUC) complicated with calculi. 【Methods】 Clinical data of 7 UTUC with calculi patients treated during Sep.2018 and Apr.2022 were retrospectively analyzed, including general data, time from visit to diagnosis, imaging data, urine exudation cytological results, surgical methods, pathological stages and follow-up data. 【Results】 The ratio of male to female was 3∶4, and the mean age was 66.4 (55-72) years. The initiate imaging examination results only showed calculi, but did not indicate suspicious tumor (including 1 case with missing data). The median time from the first visit to diagnosis was 12 months (5-36 months). Of all 7 cases, 2 (2/4) were clinically diagnosed by enhanced CT, 3 (3/4) by MRI, and 2 (2/7) by positive urine exudation cytology. All patients received surgical treatment. Postoperative pathology showed 85.71% (6/7) were high-grade UTUC. Postoperative staging was T1N0M0 in 4 cases, T3N0M0 in 2 cases, and T4N2M0 in 1 case. Adjuvant chemotherapy was conducted in 2 cases. During the median follow-up of 12 months (6-41), 1 case developed multiple systemic metastases in month 9, while the other cases had no recurrence or metastasis. 【Conclusion】 For UTUC patients without obvious filling defect on imaging, especially when ipsilateral calculi were complicated, misdiagnosis should be alerted for timely treatment and better prognosis.
RESUMEN
Objective:To compare the complications associated with various urinary flow diversion methods and identify the factors that contribute to the decline in renal function after radical total cystectomy for myoinfiltrating urothelial carcinoma.Methods:This study conducted a retrospective analysis on the clinical data of 46 patients with pathologically confirmed muscle-invasive bladder cancer.The patients underwent laparoscopic radical cystectomy with either ileal conduit diversion(n=21)or ureterocutaneous diversion(n=25)between January 2017 and December 2021.Perioperative data, postoperative pathology, postoperative complications, and follow-up results were compared between the two groups.Results:The study found significant differences between the two groups in terms of age[(67±6)years vs.(73±8)years, t=3.132, P=0.003], Charlson comorbidity index adjusted for age[(3.80±1.15) vs.(4.52±1.03), t=2.223, P=0.031], prognostic nutritional index[(48.81±5.74) vs.(43.64±4.74), t=3.347, P=0.002], operation time[(449±108)minutes vs.(326±130)minutes, P=0.001]], hospital stay[(20.1±11.1)days vs.(13.3±5.2)days, t=2.762, P=0.008], proportion of Clavien grade 3 or higher complications within 3 months after surgery(4/21 vs 0/25, χ2=2.105, P<0.05), and proportion of stoma-free patients(18/21 vs.5/25, χ2=6.373, P<0.01). According to Logistic multivariate analysis, perioperative blood transfusion and urinary tract infection were identified as independent risk factors for renal function decline 12 months after surgery.Escherichia coli was found to be the most common bacteria cultured from urinary tract infections in both groups after surgery. Conclusions:Laparoscopic radical cystectomy with ureterocutaneous diversion offers benefits such as shorter hospital stays and fewer perioperative complications for older and frail patients.However, a higher proportion of patients may require ureteral stenting.It is important to note that perioperative blood transfusion and urinary tract infection are major risk factors for renal function decline following radical cystectomy.
RESUMEN
Objective:To investigate the clinical features, diagnosis, treatment and prognosis of primary urethral carcinoma.Methods:The clinical and follow-up data of 12 patients with primary urethral carcinoma admitted to Beijing Hospital from July 2016 to December 2020 were retrospectively analyzed.Results:There were four males and eight females, with an average age of 66.3(53~75)years.Nine patients underwent magnetic resonance examination before operation, and eight patients presented with abnormal urethral signals.The clinical stage of female patients was generally later than those of male patients, and all patients received surgical treatment.Four male patients did not receive post-operative adjuvant treatment, and all of them attained disease-free survival.Among the eight female patients, four patients received postoperative adjuvant radiotherapy or chemotherapy, five patients had recurrence or metastasis during follow-up, and two patients died.Conclusions:The clinical stage of female urethral cancer is later than that of male.MRI examination is beneficial to the determination of local invasion of urethral cancer.For female proximal urethral cancer and male posterior urethral cancer, radical resection has a good therapeutic effect.
RESUMEN
Objective:To assess the efficacy of Tamsulosin monotherapy for overactive bladder(OAB)symptoms in benign prostatic hyperplasia(BPH)patients with the prostate volume(PV)<40 ml, and to analyze related factors affecting the efficacy.Methods:300 BPH patients with OAB were enrolled, with an average age of(66.9±7.7)years and the PV<40 ml.Smoking, drinking and other living habits were investigated.Data on the Overactive Bladder Symptom Score(OABSS), International Prostate Symptom Score(IPSS)and Quality of Life Scale(QOLS)were collected before and after 4 weeks of treatment with Tamsulosin 0.2 mg QN.The maximum urine flow rate(Qmax)and bladder residual urine volume(PVR)were measured before and after treatment.OBASS was used as the main assessment parameter to analyze the correlation of efficacy with age, lifestyle, pre-treatment symptom scores, PV, Qmax and PVR.Results:257 patients completed the study, and 169 patients were treated effectively, with an overall effectiveness rate of 65.8%.The effectiveness rates of the mild, moderate and severe OAB groups were 83.6%, 62.4% and 38.5%, respectively, with statistical significance( χ2=13.037, P=0.001).3 patients showed adverse drug reactions, including 2 patients with mild dizziness and 1 patient with nausea.The baseline OABSS score, the proportion of smoking patients and the proportion of drinking patients in the effectively treated OAB group were significantly lower than those in the ineffectively treated group.Multivariate analysis showed that baseline OABSS score( OR=0.735, P<0.001)and smoking( OR=2.111, P=0.029)were correlated with tamsulosin's efficacy in treating BPH patients with OAB with PV<40 ml. Conclusions:The effectiveness rate of Tamsulosin for the treatment of BPH patients with mild OAB with PV<40 ml is high.The baseline OABSS score and smoking are factors affecting the efficacy of Tamsulosin on OAB symptoms in these patients.
RESUMEN
Objective:To determine the predictive value of preoperative monocyte-to-lymphocyte ratio(MLR) for prognosis in elderly patients with upper tract urothelial carcinoma (UTUC) after radical nephroureterectomy(RNU).Methods:A retrospective study was performed on 168 elderly patients who underwent RNU in Beijing Hospital between March 2004 to February 2019.Males accounted for 44.6% (75 patients) and females 55.4%(93 patients) of the patients. Median age at the time of surgery was 73(69-78) years, and 110 (65.5%) patients suffered from hydronephrosis. There were 147 cases(87.5%)with single tumor, and 21 cases(12.5%)with multiple tumors, including 75(46.6%) cases in renal pelvis or pelvi-ureteric junction, and 93(53.4%)cases in ureter. Open RNU was performed in 106(63.1%) patients, and laparoscopic method in 62(32.9%) patients. The optimal cutoff value of MLR was set as 0.22 by using the median.χ 2 test, which was used to detect the association between MLR(≤0.22 vs.>0.22) and clinicopathological variables. Survival analyses were performed using the Kaplan-Meier method and were compared using the log-rank test. Additional subgroup analyses(low grade vs. high grade) were performed according to pathological grade. Univariate and multivariate analysis by Cox’s proportional hazards model was used to determine the significance of MLR in respect to OS and PFS. Results:The follow-up period ranged from 19.2 to 86.9 months (median 51.9 months). Next, the cohort was divided into 2 groups , including 77 patients with low MLR(≤0.22) and 91 patients with high MLR(>0.22). High MLR was significantly more frequent in male patients(31.2% vs.56.0%), as well as those undergoing laparoscopic surgery (54.5% vs.70.3%)(All P<0.05). Based on a Cox univariate proportional hazards analysis, male gender( HR=1.793, 95% CI 1.003-3.205, P=0.049), presence of lymph node metastasis( HR=6.809, 95% CI 2.124-17.454, P=0.001) and high MLR( HR=2.287, 95% CI 1.259-4.154, P=0.007)were associated with poor OS. Male gender( HR=1.758, 95% CI 1.066-2.902, P=0.027), presence of lymph node metastasis( HR=6.524, 95% CI 2.542-16.748, P<0.001), lymphovascular invasion(LVI) ( HR=2.348, 95% CI 1.139-4.838, P=0.021), high MLR( HR=2.801, 95% CI 1.657-4.735, P<0.001)and PLR( HR=1.663, 95% CI 1.003-2.757, P=0.049) were significantly associated with subsequent PFS. By multivariate analysis, tumor site( HR=2.050, 95% CI 1.079-3.892, P=0.028), lymph node metastasis ( HR=6.641, 95% CI 1.852-23.811, P=0.004) and MLR( HR=2.089, 95% CI 1.062-4.113, P=0.033) were the independent risk factors for OS in elderly patients with UTUC. Tumor side( HR=2.024, 95% CI 1.033-3.965, P=0.040), multifocality ( HR=2.992, 95% CI 1.161-7.713, P=0.023), lymph node metastasis ( HR=6.454, 95% CI 2.026-20.564, P=0.002) and MLR( HR=2.866, 95% CI 1.554-5.284, P=0.001) were associated with PFS.The multivariate analysis of the significant risk factors established a postoperative risk stratification model for OS and PFS. The results showed significant differences among the 3 subgroups of patients with low(0 risk factor), intermediate(1 risk factor), or high risk(2-3 risk factors)(All P<0.05). Conclusion:MLR was an independent risk factor for OS and PFS in elderly patients with UTUC and patients with elevated MLR have worsen prognosis.
RESUMEN
Objective:To evaluate the efficacy and safety of docetaxel+ prednisone in the treatment of castrated resistant prostate cancer in patients over 75 years old.Methods:In this study, 118 metastatic castration resistant prostate cancer (mCRPC) patients over 60 years old treated in Beijing Hospital from February 2013 to December 2019 were retrospectively analyzed. The median age of the patients was 72 (65, 77)years, ECOG scores ≤2. All 118 cases had bone metastasis, 5 cases had visceral metastasis. A total of 40 patients chose docetaxel as the first-line treatment of mCRPC, and the remaining 78 patients chose docetaxel as second-line or third-line treatment. The study included 53 patients >75 years old and 65 patients aged 60-75 years. The age of patients in the two groups were 67 (63, 71) years old and 78 (76, 83) years old, the difference was statistically significant ( P<0.05). Among them, there were 24 cases with Gleason score ≤7 and 41 cases with Gleason score >7 in 60-75 years old group, and 30 cases with Gleason score ≤7 and 23 cases with Gleason score >7 in the group of >75 years old, with significant difference between the two groups ( P = 0.034). Sixty-one patients received endocrine therapy and 4 received orchiectomy in the 60-75 years old group; 43 patients received endocrine therapy and 10 received orchiectomy in the group of >75 years old, the difference was statistically significant ( P=0.035). There were 37 cases with ECOG 0 score, 25 cases with 1 scores and 3 cases with 2 scores in the group of 60-75 years old; there were 5 cases with ECOG 0 score, 38 cases with 1 score and 10 cases with 2 score in the group of >75 years old, with significant difference between the two groups ( P<0.05). There was no significant difference in PSA level[ 90 (35.5, 258) ng/ml vs. 115 (60, 296) ng/ml], G8 scale score [(14.3±2.1 vs. 13.6±1.1)], Mini-Cog score[3(2, 3) vs. 3(1, 3)], and visceral metastasis [2 cases (3.1%) vs. 3 cases (5.7%)]( P>0.05). The efficacy and safety of docetaxel in the two groups were further observed. Results:The median follow-up time was 21.5 (6, 62) months. There was no significant difference in chemotherapy cycle [(6.1±1.3) vs. (6.8±1.7)] and chemotherapy dose [(70.3±4.3) mg/m 2 vs. (66.3±5.2) mg/m 2] between the 60-75 years old group and the >75 year old group ( P> 0.05). The PSA response rate [72.3%(47/65)vs.66.0%(35/53)], pain relief rate [45.0% (9/20) vs. 54.5% (6/11)], and median progression-free survival[6.1 (1.4, 11.2) months vs. 5.9 (2.0, 12.0) months] had no statistical significance ( P>0.05). There were no deaths in the two groups during chemotherapy. The median overall survival(OS) of patients aged 60-75 years and those >75 years old who received docetaxel as first-line treatment were 26.5 (16.1, 31.3) months and 24.8 (17.5, 28.4) months, respectively ( P=0.223). The median OS of the two groups were 17.3 (13.2, 20.5) months and 15.4 (12.3, 20.0) months with docetaxel treatment as second or third line treatment ( P=0.331). There were 3 cases (4.6%) and 5 cases (9.4%) of grade 3 adverse reactions in 60-75 years group and >75 years old group, respectively. Grade 3 leukopenia occurred in 1 case time (1.5%) and 2 cases (3.8%) respectively. Grade 3 neutropenia fever occurred in 1 case time in both groups. There was no significant difference in the incidence of above complications between the two groups ( P > 0.05). Conclusions:The efficacy and safety of docetaxel + prednisone chemotherapy for mCRPC patients >75 years old were similar to those of 60-75 years old. Age should not be the absolute contraindication of docetaxel for prostate cancer chemotherapy.
RESUMEN
Objective:To investigate the value of serum IL-23 in predicting the progression of prostate cancer at different stages of treatment.Methods:A total of 124 patients with metastatic prostate cancer diagnosed in Beijing Hospital from June 2018 to March 2019 were collected.Patients were TNM-staged according to the Prostate Cancer Guidelines of the European Association of Urology.Serum IL-23 levels were measured in patients with metastatic castration resistance prostate cancer(mCRPC), metastatic castration sensitive prostate cancer(mCSPC)and benign prostatic hyperplasia(BPH), respectively.Patients with mCRPC were subgrouped based on disease stability, and serum IL-23 levels were compared between the subgroups.Serum IL-23 levels in the groups were analyzed and compared with the Gleason score and the prostate-specific antigen(PSA)level.Results:The median value of serum IL-23 in the mCRPC group was 79.73(45.61, 95.63)μg/L, which was higher than that in the BPH group[30.88(15.01, 44.94)μg/L, Z=22.66, P=0.000]and the mCSPC group[46.10(35.27, 80.92)μg/L, Z=11.46, P=0.001]. Serum IL-23 levels were higher in the mCSPC group than in the BPH group( Z=7.17, P=0.007). Analysis for the subgroups showed that the median value of serum IL-23 was 110.25(88.47, 159.09)μg/L in mCRPC patients with unstable disease, which was higher than that in mCRPC patients with stable disease[46.52(44.97, 80.33)μg/L, Z=33.99, P=0.000]. There was no significant difference in serum IL-23 levels between mCRPC patients with stable disease and mCSPC patients[46.10(35.27, 80.92)μg/L]( Z=0.35, P=0.554). Conclusions:Serum IL-23 can be used as a potential biological indicator to predict the therapeutic effect of mCSPC and to predict tumor metastasis.
RESUMEN
Objective To investigate the effects of radical prostatectomy on the overall survival (OS)and tumor-specific survival in prostate cancer(PCa)patients aged 75 years and older.Methods Clinical data of patients aged 75 and older with localized PCa from Surveillance,Epidemiology,and End Results(SEER)Database from 2004 to 2016 were retrospectively analyzed.There were 17 899 cases of PCa undergoing radical prostatectomy and 3 648 cases of PCa without surgery in this study.The OS and prostate cancer-specific survival(PSS)were compared between the surgery group and the nonsurgery group.Results For 75-79-year-old patients with high-risk localized PCa,the OS and PSS in the surgery group were better than in the non-surgery group (OR =1.49,95 ％ CI:1.22 ～ 1.82,P ＜ 0.01;OR=1.43,95％CI:1.09～2.04,P＜0.05).For patients aged 75-79 years with low-risk PCa and patients aged 80 years and older with low-,middle-,or high-risk PCa,the OS was worse in the surgery group than in the non-surgery group(OR =0.54,95％CI:0.38～0.76,P＜0.01;OR =0.47,95％CI:0.34～0.66,P＜0.01;OR =0.58,95％CI:0.44～0.78,P＜0.01;OR =0.59,95％CI:0.51 ～0.68,P＜0.01).For patients aged 75-79 years with low-or medium-risk PCa and patients aged 80 years and older with medium-risk PCa,there was no statistical difference in PSS between the surgery and non-surgery groups(P＞0.05).Conclusions Age limits for prostatectomy should be extended as a result of increasing average life expectancy.Patients aged 75-79 years with high-risk PCa can be considered for surgical treatment,while it should not be recommended for patients aged 75-79 years with low-or medium-risk localized PCa or aged more than 80 years.Many factors should be considered in making treatment decisions for prostate cancer.
RESUMEN
Objective To evaluate the value of kidney-sparing surgery in the treatment of upper urinary tract urothelial tumors by retrospectively analyzing and comparing the clinical data of elderly patients with upper urinary tract urothelial tumors between patients undergoing kidney-sparing surgery and nephroureterectomy in our hospital during the same period.Methods Thirty elderly patients with upper urinary tract urothelial tumors were treated with kidney-sparing surgery(ureteroscopy,segmental ureteral resection)and followed up from April 2004 to July 2017.One hundred and fortynine patients who underwent nephroureterectomy during the same period were selected as the control group.The survival rate and local recurrence rate were compared between the two groups.Results In the kidney-sparing group,23 cases were pathologically diagnosed as tumors,3 cases as inflammatory polyps and 4 cases without pathological findings.There were no statistically significant differences between kidney-sparing surgery and nephroureterectomy in bladder recurrence[4 cases(13.3％)vs.24 cases(16.1％),x2 =0.011,P =0.915],pelvic orthotopic recurrence [3 cases (10.0％) vs.6 cases (4.0％),x2 =0.825,P=0.364],cancer-specific death rate[2 cases(6.7％)vs.16 cases(10.7％),x2=0.118,P=0.731]and overall survival rate[4 cases(13.3％)vs.22 cases(14.8％),x2 =0.410,P =0.550].There were no significant differences between kidney-sparing surgery versus nephroureterectomy among postoperative 1-year,5-year and 10-year in the overall survival rates (100.0 ％vs.95.1％、85.9 ％ vs.84.1％、80.5 ％ vs.60.8 ％,P =0.156),tumor-specific survival rates (100.0 ％ vs.95.1％,85.7 ％ vs.87.6 ％,85.7 ％ vs.76.8 ％,P =0.380) and progression-free survival rates(100.0％vs.100.0％,90.9％vs.96.0％,90.9％ vs.79.7％,P =0.680).Conclusions Elderly patients have poor physical conditions and poor tolerance to radical surgery with a significant damage on postoperative renal function.Kidney-sparing surgery(ureteroscopy,segmental ureteral resection) as the treatment of upper urinary tract tumors can minimize the risk of surgery and optimize the quality of life.The individual assessment based on individual conditions,postoperative complications,and the recovery of renal function should be conducted and the operation with the greatest benefit should be adopted.
RESUMEN
Objective To investigate the relationship between preoperative urodynamic parameters and the improvement of overactive bladder (OAB)symptoms after GreenLight laser vaporization,and to explore prognostic factors for improvement of OAB symptoms in the elderly.Methods A retrospective study was conducted in 100 benign prostatic hyperplasia (BPH)patients undergoing GreenLight laser vaporization at the Department of Urology of Beijing Hospital from July 2015 to March 2017.All patients completed a preoperative urodynamic examination and received GreenLight laser vaporization.Clinical data including age,prostate-specific antigen (PSA),prostate volume,international prognostic scoring system(IPSS),overactive bladder symptom score (OABSS),quality of life(QOL)and urodynamic parameters were collected.The related factors for improvement of OAB symptoms after GreenLight laser vaporization were analyzed by a binary Logistic regression analysis.Results All patients underwent surgery successfully and completed a 12-month follow-up.Both urinary storage and voiding symptoms improved at 3 and 12 months after GreenLight laser vaporization(P＜0.05).The scores of IPSS,IPSS storage (IPSS-S),IPSS voiding (IPSS-V),OABSS and QOL and nighttime voiding frequency decreased and urinary storage and voiding symptoms improved at 3 and 12 months after GreenLight laser vaporization,compared with pre-surgery data(P＜0.05).The success rates of storage symptom improvement at 3 and 12 months after GreenLight laser vaporization were 62.0 ％ (62/100) and 68.0 ％ (68/100) evaluated by IPSS-S and 68.0 ％ (68/100) and 75.0％ (75/100)by OABSS,respectively.Multiple Logistic regression analysis showed that age,detrusor contractility,residual urine volume and nighttime voiding frequency were independent influencing factors for prognosis(OR =35.714,0.352,0.110 and 0.040,P =0.000,0.027,0.018 and 0.002).Conclusions GreenLight laser vaporization is an effective method in treating BPH with OAB.Age is an independent unfavorable factor and the residual urine volume,nighttime voiding frequency and detrusor contraction are independent influencing factors for prognosis.Enough attention should be paid to these related parameters before surgery.
RESUMEN
Objective To explore the efficacy of the single versus combination drug therapies for benign prostatic hyperplasia(BPH) combined with overactive bladder(OAB).Methods A total of 471 outpatients with BPH and OAB meeting the inclusion/exclusion criteria were enrolled in this prospective cohort study from March 2012 to October 2015.Patients were divided into two groups:(1) the single alpha-blocker treatment group (prostate volume ＜ 30 ml),and (2) the 5 alpha reductase inhibitors(5-ARIs) plus alpha-blocker combination treatment group(prostate volume ≥ 30 ml).The 318 patients were treated with alpha blockers for 4 weeks,and then received a continuing alpha-blocker treatment for 8 weeks if IPSS score changes were less than 30％ (i.e.single alpha-blocker treatment group).And 153 patients were treated with 5-ARIs for 12 weeks,then received 5-ARIs plus alpha-blocker combination treatment for another 4 weeks(a total of 16 weeks)if IPSS score changes were less than 30 ％ (i.e.combination treatment group).The improvements of post-voiding residual(PVR),PV,maximum urinary flow rate(Qmax),international prostate symptom score(IPSS),overactive bladder symptom score (OABSS),quality of life (QOL),urine storage period symptom score (USPSS) and voiding symptom score(VSS)were compared between the two groups.Results The values of IPSS,OABSS,QOL,USPSS and VSS index in the two groups were improved after treatment as compared with pre-treatment(all P≤0.05).Patients in combination treatment group had little improvement in PVR and Qmax after treatment.The OAB symptom remission rates of BPH patients with OAB in single alpha-blocker treatment group were 70.5％ (206/292)and 78.6％ (165/210)after 4 and 12 weeks of treatment respectively.The OAB symptoms remission rates of BPH patients with OAB in combination treatment group were 54.5 ％ (64/122) and 67.1％ (53/79) after 12 and 16 weeks of treatment respectively.Conclusions Both single alpha-blocker treatment and alpha-blocker plus 5ARIs combination treatment,which identification was based on prostate volume,have good effects on BPH patients with OAB.The single alpha-blocker treatment can improve PVR and Qmax,and the alpha-blockers plus 5ARIs combination treatment can improve the prostate volume in BPH patients with OAB.
RESUMEN
The clinical efficacy and safety of RevoLix 2 μm continuous wave laser vaporesection in treatment of senile patients with benign prostatic hyperplasia (BPH) were retrospective evaluated.In 291 senile patients with BPH,213 received 2 μm continuous wave laser vaporesection (group A) and other 78 patients received transurethral resection of prostate (TURP, group B).Compared with group B the intraoperative blood loss was less, the bladder irrigation time, catheter time and hospitalization time were shorter in group A.The subjective or objective indexes were all significantly improved at 3 and 12 months after laser treatment.The improvements of international prostate symptom score (IPSS), IPSS-S, overactive bladder symptom score (OABSS) in patients of 70-79 were more marked than those of 80 or older.Patients with mild overactive bladder (OAB) had less improvement in IPSS and IPSS-S than those with moderate-severe OAB which suggest that the storage symptoms could be improved significantly by removing obstruction.
RESUMEN
Objective To verify the short and medium term effect of dutasteride in the treatment of lower urinary tract symptoms ( LUTS) secondary to benign prostatic hyperplasia( BPH) with prostate volume≥40 ml.Methods One hundred and seven patients diagnosed as BPH accompanying moderate-to-severe LUTS who met the inclusion/exclusion criteria were enrolled from July 2013 to September 2014.After 12 weeks of treatment with dutasteride 0.5 mg/d, the primary outcome was international prostate symptom score (IPSS) change from baseline at Week 12, and the secondary outcome was Quality of Life (QOL) score before and after the treatment, maximun flow rate ( Qmax ) , and the change in residual urine volume. Comparing with baseline, patients with the rate of IPSS decline ≥30% ( effective group) continued taking dutasteride for another 4 weeks then undergoing the prostate volume and PSA measurement.In addition, patients with the rate of IPSS decline <30% were administered combination therapy with dutasteride and tamsulosin (0.2mg/d), their IPSS at Week 16 were compared with that at Week 12, and their prostate volume and PSA level were followed up until Week 20.The prostate volume and PSA changing were followed up.Results Compared with baseline, after 12 weeks of treatment with dutasteride, patients'IPSS decreased 5.54 points ( P <0.01 ) , including 59 patients ( 55.14%) with IPSS decline rate ≥30%, QOL score decreased 1.56 points (P<0.01), Qmax increased 1.07 ml /s (P=0.049), and residual urine decreased 6.46 ml (P=0.107).IPSS declined ≥30% in 42 patients at Week 12, whose prostate volume reduced 14.15%at Week 16 follow-up, with PSA declining of 0.68 ng /ml in 32 tested cases ( P=0.008).IPSS declining <30%in 36 patients at Week 12 was followed up to Week 20, and their prostate volume reduced 11.89%, with PSA declining of 0.18 ng/ml ( P=0.589) in 33 tested patients.Conclusions Dutasteride can improve the lower urinary tract symptom in patients who are diagnosed as BPH accompanying moderate-to-severe LUTS with prostate volume ≥ 40 ml significantly.Tamsulosin add-on treatment benefited most patients.
RESUMEN
Objective To investigate the effect of endoscopic management of upper tract urothelial carcinoma (UTUC),and evaluate the indication and clinical value of postoperative prophylactic pelviureteric instillation chemotherapy.Methods Patients who met the inclusion criteria included elderly patients,patients who could not tolerate radical surgery,patients with renal insufficiency or needed dialysis after removal of the kidney,patients with bilateral UTUC,patients with tumor≥3 cm in diameter but could be completely resectted under ureteroscopy who required to preserve renal function.Surgical procedure was successful.The ureteral stents were placed,and prophylactic ureteral infusion chemotherapy via the retrograde transvesical ureteric catheterisation was conducted 1-2 times one week at 2 days after surgery.40 milligram of pirarubicin hydrochloride or epirubicin hydrochloride was dissolved in 40 milliliter sterile water for the prophylactic infusion chemotherapy.These instillations were completed within 40 minutes.Results Totally,9 patients (3 males and 6 females) aged 60-86 years,mean age of (69.7±6.4) years,were enrolled in this study.The carcinoma of the renal pelvis was found in 2 cases and ureteral tumors in 7 cases.In pathological results,ureteral polyps was found in 1 case,papillary ureteral neoplasm with low malignant potential in 2 cases,urinary tract epithelial carcinoma in 4 cases (1 case with poorlydifferentiation,1 case with well-differentiation,2 cases with urinary tract epithelial cancer),and 2 cases were lack of pathological reports because of too few pathologic specimens.4 patients received adjuvant chemotherapy by instillation successfully,and lumbago,fever or other complications were not found.Patients were followed up for a mean period of 15 moths (4-31 months).Only 1 patient had recurrence of bilateral ureteral tumor 15 months after surgery,and no tumor recurrence was found in other patients.Conclusions Endoscopic management is a safe and effective in treating UTUC,which can preserve renal function by avoiding nephrorectomy in some patients.The instillation chemotherapy after endoscopic management is safe,which has a satisfactory effect,but further validation in a large clinical sample is needed.Patients with tumor resection under ureteroscopy who cannot obtain the pathology results need to be closely followed up.