68Ga-PSMA ligand PET/CT integrating indocyanine green-guided salvage lymph node dissection for lymph node metastasis after radical prostatectomy / 亚洲男科学杂志(英文版)

To efficiently remove all recurrent lymph nodes (rLNs) and minimize complications, we developed a combination approach that consisted of 68Gallium prostate-specific membrane antigen (PSMA) ligand positron emission tomography (PET)/computed tomography (CT) and integrated indocyanine green (ICG)-guided salvage lymph node dissection (sLND) for rLNs after radical prostatectomy (RP). Nineteen patients were enrolled to receive such treatment. 68Ga-PSMA ligand PET/CT was used to identify rLNs, and 5 mg of ICG was injected into the space between the rectum and bladder before surgery. Fluorescent laparoscopy was used to perform sLND. While extensive LN dissection was performed at level I, another 5 mg of ICG was injected via the intravenous route to intensify the fluorescent signal, and laparoscopy was introduced to intensively target stained LNs along levels I and II, specifically around suspicious LNs, with 68Ga-PSMA ligand PET/CT. Next, both lateral peritonea were exposed longitudinally to facilitate the removal of fluorescently stained LNs at levels III and IV. In total, pathological analysis confirmed that 42 nodes were rLNs. Among 145 positive LNs stained with ICG, 24 suspicious LNs identified with 68Ga-PSMA ligand PET/CT were included. The sensitivity and specificity of 68Ga-PSMA ligand PET/CT for detecting rLNs were 42.9% and 96.6%, respectively. For ICG, the sensitivity was 92.8% and the specificity was 39.1%. At a median follow-up of 15 (interquartile range [IQR]: 6-31) months, 15 patients experienced complete biochemical remission (BR, prostate-specific antigen [PSA] <0.2 ng ml-1), and 4 patients had a decline in the PSA level, but it remained >0.2 ng ml-1. Therefore, 68Ga-PSMA ligand PET/CT integrating ICG-guided sLND provides efficient sLND with few complications for patients with rLNs after RP.

Functional outcomes of transvesical single-site versus extraperitoneal laparoscopic radical prostatectomy for low-risk prostate cancer / 中华男科学杂志

<p><b>OBJECTIVE</b>To compare the perioperative data, pathological results and functional outcomes of transvesical single- site laparoscopic radical prostatectomy (TVSSLRP) with those of nerve-sparing extraperitoneal laparoscopic radical prostatectomy (nsELRP) in the treatment of low-risk prostate cancer (PCa).</p><p><b>METHODS</b>Fifty patients with low-risk organ-confined PCa were randomly assigned to two groups of equal number to receive TVSSLRP and nsELRP, respectively. Comparisons were made between the two groups of patients in such demographic and baseline data as age, comorbidity, body mass index (BMI), serum prostate-specific antigen (PSA), prostate volume, bioptic Gleason score, clinical stage, IIEF-5 score, nocturnal penile tumescence (NPT), penile brachial index (PBI), and penile arterial blood flow velocity as well as in such surgery-related parameters as operation duration, blood loss, blood transfusion, intraoperative complications, positive surgical margin, catheterization time, hospital stay, and postoperative Gleason score, pathologic stage, urinal pad use, PSA level, IIEF-5 score, NPT, PBI and PABFV.</p><p><b>RESULTS</b>All the operations were successfully performed. There were no statistically significant differences between the two groups either in the demographic and baseline data or in intraoperative blood loss, blood transfusion rate, complications, and positive surgical margin. No intraoperative complications and positive surgical margins were found in either group. Compared with nsELRP, TVSSLRP achieved a significantly shorter operation duration ([151.46 ± 40.68] min vs [105.92 ± 26.21] min, P <0.05), catheterization time ([13.01 ± 1.64] d vs [11.24 ± 1.17] d, P <0.05), and hospital stay ([15.76 ± 4.65] d vs [12.92 ± 4.29] d, P <0.05). On the first day and at 1, 3 and 6 months after catheter removal, the urinary continence rates in the TVSSLRP and nsELRP groups were 84% vs 52% (P <0.05), 100% vs 84%, 100% vs 96%, and 100% vs 96%, respectively; and at 3, 6 and 12 months after surgery, the erectile potency rates were 48% vs 28% (P <0.05), 64% vs 52%, and 76% vs 68%, respectively, with an IIEF-5 score ≥ 18, all evidently higher in the TVSSLRP than in the nsELRP group. The penile brachial index and arterial blood flow velocity of the two groups of patients exhibited no significant differences before and after surgery, nor did postoperative complications (grade II) between the TVSSLRP and nsELRP groups (32% vs 40%, P >0.05). The Gleason score and pathologic stage were increased after surgery, but with remarkable differences between the two groups (P >0.05). No biochemical recurrence was found in either group during a 12-month follow-up.</p><p><b>CONCLUSION</b>With the advantages of safety and rapid postoperative recovery, both TVSSLRP and nsELRP are feasible for the treatment of low-risk organ-confined PCa, but the former may achieve an earlier recovery of urinary continence and erectile function than the latter.</p>

Single-port laparoscopic radical prostatectomy: initial experience and technical points to reduce its difficulties / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Laparoendoscopic single-site surgery (LESS) approaches have been reported for treating various kidney and pelvic procedures, and are feasible and effective in selected patients. In this study, we aimed to present the initial experience and evaluate the efficacy of laparoscopic radical prostatectomy performed through a single incision using a multichannel port.</p><p><b>METHODS</b>Between July 2010 and April 2011, six patients diagnosed with early stage prostate cancer underwent LESS radical prostatectomy (RP) in our institute. A multichannel port was inserted transperitoneally through a 2-cm umbilical incision. Specially articulating and flexible laparoscopic were used. Some technical tricks and points were applied during the operation to overcome the drawbacks and reduce the difficulties of this approach. Two continuous urethrovesical sutures in both sides were performed to complete both lateral aspects of anastomosis. The two ends of the suture threads were fixed by double Lapro-Clips, instead of the difficult knot-tying.</p><p><b>RESULTS</b>Total operative time was (265 ± 43) minutes. Mean blood loss was (230 ± 65) ml. All cases were completed successfully, without conversion to open surgery or adding additional abdomen ports. No patient required a blood transfusion and no intraoperative complications occurred. The Foley catheter was removed at the 14th day (range 12th - 16th) after surgery. At the 12th week of follow-up, all patients had an undetectable prostate-specific antigen level. Two patients used 2 or 1 pad for continence daily; other patients had achieved good continence.</p><p><b>CONCLUSION</b>In selected cases, LESS-RP is feasible and effective; these technic points and the flexible-articulating instruments are helpful to reduce the operation difficulties.</p>

Reduced expression of alpha-tocopherol-associated protein is associated with tumor cell proliferation and the increased risk of prostate cancer recurrence / 亚洲男科学杂志(英文版)

<p><b>AIM</b>To examine the impact and prognostic significance of alpha-tocopherol associated protein (TAP) expression in a series of prostate cancer patients.</p><p><b>METHODS</b>Tissues from 87 patients underwent radical prostatectomy were examined for TAP expression by immunohistochemistry. The relationships of the staining results, the clinic pathological characteristics and the recurrence times were analyzed.</p><p><b>RESULTS</b>Compared with the adjacent areas of normal and benign glands, immunoreactivity of TAP was reduced in areas of prostate cancer. A lower TAP-positive cell number per mm(2) of the largest cancer area (defined as TAP-PN) was associated with higher clinical stage (r = -0.248, P = 0.0322). Inverse associations were found among the TAP-PN and positive lymph nodes (r = -0.231, P = 0.0325), preoperative prostate-specific antigen (PSA) levels (r = -0.423, P = 0.0043), tumor size (r= -0.315, P= 0.0210) and elevated tumor cell proliferation, which was indicated by the staining of Ki-67 (r = -0.308, P = 0.0026). TAP-PN was a significant predictor of recurrence univariately (P = 0.0006), as well as multivariately, adjusted for known markers including preoperative PSA, clinical stage, Gleason score, surgical margin, extra-prostatic extension, seminal vesicle invasion and lymph node metastasis (P = 0.0012).</p><p><b>CONCLUSION</b>Reduced expression of TAP was associated with the cell proliferation status of prostate cancer, adverse pathological parameters and the increased risk of recurrence.</p>

Analysis of the causes of postoperative chest or/and abdomen colic in benign prostatic hyperplasia / 中华男科学杂志

<p><b>OBJECTIVE</b>To analyze the causes of chest or/and abdomen colic with in 1 week after prostatectomy and transurethral resection of the prostate (TURP).</p><p><b>METHODS</b>Retrospective studies were made on 120 cases of benign prostatic hyperplasia (BPH) with postoperative colic in the chest or/and abdomen from October 2001 to October 2002, 35 (Group A) treated by prostatectomy and the other 85 (Group B) by TURP.</p><p><b>RESULTS</b>In sequence of frequency, the causes of the postoperative chest or/and abdomen colic were bladder spasm, catheter block, acute gastroenteritis, angina and acute myocardial infarction.</p><p><b>CONCLUSION</b>The causes of chest or/and abdomen colic after prostatectomy are multiple. If the causes are timely established and corresponding measures immediately taken, its complications can be minimized.</p>

Early detection and treatment of pyonephresis(report of 41 cases) / 中华泌尿外科杂志

Objective To improve the level of early detection and treatment of pyonephrosis. Methods This study included 41 cases(17 men and 24 women;mean age,49 years)of pyonephrosis.A variety of examinations,including urinary analysis,blood analysis,kidney nuclear medicine scan,ultrasonog- raphy,intravenous urography(IVU),and CT were used for the early diagnosis of pyonephrosis.Pereutaneous nephrostomy(PCN)drainage was done for the interim management of pyonephrosis,then phase 2 operation was performed in 28 cases.The double-J tube was placed in ureter by ureteroscope for drainage,and then phase 2 operation was done in 2 cases.Emergency operation was done in 10 cases.The remaining 1 case un- derwent ESWL after anti-infective therapy.Results Definite diagnosis of pyonephrosis before operation was made by invasive examinations in 31 cases(75.6%),and by percutaneous drainage in 4 cases;the other 6 cases were detected during operation.Only 6 cases(14.6%)underwent nephrectomy;the other 35 cases (85.4%)underwent kidney-sparing operation.Follow-up of 3 months to 9 years was available in 37 cases. No nephrectomy was needed in 33 cases with spared kidney.Serum creatinine was normal in the 4 cases un- dergoing nephrectomy.Conclusions The key to the treatment of pyonephrosis by kidney-sparing surgery is early diagnosis,timely drainage and relief of obstruction.Ultrasonography plays an important role in the early diagnosis of pyonephrosis,and CT has a high sensibility in the diagnosis.Pereutaneons nephrolithotomy (PCNL)secondary to drainage through pereutaneous nephrostomy was beneficial to the patients with kidney stones or upper ureter stones.