Experience in reducing intraoperative blood loss in radical retropubic prostatectomy / 中华男科学杂志

<p><b>OBJECTIVE</b>To search for an effective method of reducing intraoperative blood loss in radical retropubic prostatectomy (RRP).</p><p><b>METHODS</b>We performed RRP for 100 patients with prostate cancer, 50 (group A) with the Walsh or Poor method for handling the dorsal venous complex (DVC), and the other 50 (group B) through the following three additional procedures for hemostasis: first placing a #7 prophylactic suture in the distal position of DVC, then ligating the vascular bundle of the prostatic apex with continuous 4-0 Vicryl sutures, and lastly placing a 4-0 absorbable suture followed by freeing the neurovascular bundle (NVB) or freeing NVB before suturing the remained levator ani myofascia and the deep layer of Denovilliers' fascia above the rectal serosa with 4-0 Vicryl. We assessed the effects of the three hemostatic methods in RRP by comparing the volumes of intraoperative blood loss and transfusion, operation time and perioperative levels of hemoglobin.</p><p><b>RESULTS</b>There were no significant differences between groups A and B in age, PSA, Gleason score, clinical stage, prostate volume, operation time and perioperative hemoglobin levels (P>0.05). The volumes of intraoperative blood loss and transfusion were markedly higher in group A ([1103.00 +/- 528.03] ml and [482.00 +/- 364.60] ml) than in B ([528.00 +/- 258.96] ml and [140.00 +/- 266.28] ml) (P<0.05).</p><p><b>CONCLUSION</b>Intraoperative blood loss in RRP could be significantly decreased by placing a prophylactic hemostatic suture in the distal position of DVC, continuous suture of the vascular bundle of the prostatic apex after cutting off the urethra, and placing a fine absorbable suture above NVB or continuous suture of the remained levator ani mony fascia and the deep layer of Denovilliers'fascia above the rectal serosa with absorbable sutures after freeing NVB.</p>

Ureteroscopic lithotripsy using holmium laser for 187 patients with proximal ureteral stones / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Improving the success rate of ureteroscopic lithotripsy for proximal ureteral stones is the hot issue in this field. Here we reported our experience on the treatment of proximal ureteral stones.</p><p><b>METHODS</b>From 2005 to 2010, 187 consecutive patients with proximal ureteral stones who underwent ureteroscopic lithotripsy were enrolled. The initial 52 patients treated by semi-rigid ureteroscope alone were classified as group 1. The subsequent 135 patients treated by semi-rigid ureteroscope with the aid of stone basket and flexible ureteroscope were classified as group 2.</p><p><b>RESULTS</b>In group 1, the overall stone-free rate was 67.3%. By a single procedure of ureteroscopic lithotripsy using a semi-rigid instrument, patients with ureteral stones below the 4th lumbar vertebra level achieved 91.7% stone-free rate, which was only 50% in patients with stones above the 4th lumbar vertebra level. Conversion to open surgery occurred in two patients since ureteral perforation was observed. In group 2, the stone-free rate achieved 93.2% with the aid of an N-Trap basket, which was significantly higher than that of patients without the aid of the basket (51.6%). Flexible ureteroscope was subsequently used in patients with fragment migration, thus making the overall success rate in group 2 increases to 97.0%.</p><p><b>CONCLUSIONS</b>Ureteroscopic lithotripsy is a safe and efficacious treatment for proximal ureteral stones. A single procedure of ureteroscopic lithotripsy using semi-rigid ureteroscope could achieve a satisfactory stone-free rate in patients with proximal ureteral stones below the 4th lumbar vertebra level. However, patients with ureteral stones above the 4th lumbar vertebra level experienced higher stone-migration rate, which would decrease the success rate. Fortunately, the stone-free state could possibly be achieved with the aid of an N-trap basket and flexible ureteroscope.</p>

Retropubic radical prostatectomy: 10 years' experience with 100 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To summarize the experience and lessons from 100 cases retropubic radical prostatectomy performed in the past 10 years.</p><p><b>METHODS</b>From July 1999 to July 2009, we performed 100 cases of retropubic radical prostatectomy, of which 84 were followed up for 3 - 120 months. We analyzed their preoperative age, PSA level, amount of intraoperative blood transfusion, operation time, urinary continence, penile erectile function, stricture of the anastomotic stoma and Qmax.</p><p><b>RESULTS</b>The mean age, PSA level, amount of intraoperative blood transfusion, operation time were 66.8 yr, 20.1 ng/ml, 585.7 ml and 198.9 min; the recovery rates of bladder control at 3, 6 and 12 months postoperatively were 65.5%, 81.7% and 92.4%, respectively. At 12 months after surgery, penile erection was restored in 19 cases (42.2%), anastomotic stoma stricture developed in 5 (5.9%), Qmax averaged 20.5 ml/min, biochemical recurrence was found in 13, and 1 died from prostate cancer.</p><p><b>CONCLUSION</b>Retropubic radical prostatectomy is a desirable procedure for the treatment of local prostate cancer, in which ligation of the puboprostatic ligament and prostatic venous plexus before cutting off the ligament helps improve urinary continence, protection of the neurovascular bundle and collateral pudendal artery contributes to the recovery of penile erectile function, and proper connection of urethral and bladder mucosa can reduce anastomotic stoma stricture. Postoperative external-beam radiotherapy for those with T3a or local lymph node metastasis could decrease biochemical recurrence.</p>

The clinical observation of bipolar transurethral plasma kinetic resection of prostate for high risk benign prostate hyperplasia / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate therapeutic effect and reliability of bipolar transurethral plasma kinetic prostatectomy (TUPKP) for high risk level benign prostatic hyperplasia (BPH).</p><p><b>METHODS</b>A total of 230 cases of high risk of BPH were treated with TUPKP. Among them, 132 cases with the residual urine of 40 to 420 ml had accepted long term but inefficient medical therapy, 98 cases were suffered with repeating acute urinary retention. One hundred and seventy-three cases with the functional capacity>4 MET were performed the standard transurethral resection of the prostate (TURP), the other 57 cases with the functional capacity<4 MET were accepted the minimally invasive TURP. Among them 12 cases complicated with bladder stones accepted Ho: YAG lithotripsy priory. The international prostate symptom score (IPSS), The maximal urinary flow rate (Qmax) and residual urine of the 2 groups before and after operation were analyzed.</p><p><b>RESULTS</b>There was no transurethral resection syndrome occurred in both groups. After 3 to 12 months of follow-up postoperatively, the IPSS of the two groups were reduced from (21.9+/-5.7) and (23.7+/-5.0) to (4.4+/-2.3) and (5.5+/-2.4), residual urine were reduced from (61.8+/-18.4) ml and (103.9+/-77.3) ml to (13.0+/-6.2) ml and (15.8+/-6.1) ml, respectively. The Qmax was increased from (5.7+/-3.0) ml/s and (4.8+/-2.8) ml/s to (20.9+/-6.3) ml/s and (16.8+/-3.9) ml/s, there existed significant differences (P<0.01). However the IPSS, Qmax and residual urine of the standard group had progressed more obviously than the minimally invasive TURP group (P<0.05).</p><p><b>CONCLUSIONS</b>It is safe and effective to use TUPKP for treating high risk patients of BPH with classic TURP and minimally invasive TURP according to different functional capacity. When the functional capacity is more than 4 MET, the standard procedures is preferred.</p>

Surgical treatment of 486 cases of adrenal gland diseases: a retrospective study / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the roles of laparoscopic adrenalectomy (LA) and open adrenalectomy (GA) for treatment of adrenal gland diseases.</p><p><b>METHODS</b>The data of 486 patients with adrenal gland diseases was analyzed retrospectively during 5 years. A total of 478 patients received surgical treatments including 318 GAs and 160 LAs. The operation time, bleeding volume during operation, intestine function recovery time, pain postoperatively, hospital stay time postoperatively and postoperative complications in group GA and group LA respectively were compared.</p><p><b>RESULTS</b>All cases in group GA were successful. A total of 154 cases in group LA were successful, and 6 cases were converted to open surgery. In group LA, there were 9 cases whose tumor diameter exceeded 6 cm. There were 3 malignant cases in group LA, and no recurrence and metastasis were observed during 3-20 months follow-up. The average operation time was (112 +/- 16) mmn and (69 +/- 10) min in group GA and LA respectively. The average bleeding volume during operation was (286 +/- 23) ml, (56 +/- 10) ml in group GA and LA respectively. The average intestine function recovery time was (66 +/- 7) h, (24 +/- 7) h in group GA and LA respectively. The average frequency of treatment of pain was 1.9 +/- 0.4 and 0.5 +/- 0.1 in group GA and LA respectively. The average hospital stay time postoperatively was (10.3 +/- 1.1) d and (7.2 +/- 0.7) d in group GA and LA respectively. The rate of postoperative complications was 40.3% and 7.5% in group GA and LA respectively. All differences were significant (P = 0.023, 0.007, 0.039, 0.003, 0.029 and 0.001).</p><p><b>CONCLUSIONS</b>LA has the added benefit of shorter convalescent times, improving patients satisfaction and less associated complications, as it has proved to be as effective as OA.</p>

Prevention of incontinence after radical prostatectomy / 中华外科杂志

<p><b>OBJECTIVE</b>To discuss the effect of urine control after radical retropubic prostatectomy by preserve the membranous part of sphincter urethrae and the neurovascular bundle, or to rebuild the bladder neck.</p><p><b>METHODS</b>The radical retropubic prostatectomy was performed on a total of 32 cases of prostate cancer. We preserve the membranous part of sphincter urethrae and the neurovascular bundle lateral to the prostate. We evaginate the posterior wall of the bladder adequately and make an additional folding stitch to rebuild the bladder neck.</p><p><b>RESULTS</b>The follow up is of 6-72 months. All patients could void without difficulty, no tumor recurrence and only 2 cases occurred slight incontinence. Other 30 cases regained the ability of controlling their urinations within 6 months.</p><p><b>CONCLUSIONS</b>The incontinence after radical retropubic prostatectomy could be reduced by the method of preserving the membranous part of sphincter urethrae and preserving the neurovascular bundle lateral to the prostate in operation. It could also be avoided by evaginate the posterior wall of the bladder adequately and make an additional folding stitch to the bladder neck.</p>

Primary pigmented nodular adrenocortical disease report of 5 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To study the pathology, diagnostic and therapeutic method of primary pigmented nodular adrenocortical disease (PPNAD).</p><p><b>METHODS</b>The data of 5 cases of PPNAD were analyzed retrospectively. Among the 5 cases, 2 were male and 3 were female. The range of age was from 12 to 53 years. All the 5 cases had symptoms of Cushing syndrome. The diagnose depended on the results of endocrine exams, ultrasound, CT, MR and pathological reports. All patients received operation of unilateral adrenalectomy. The therapeutic effects were determined by post-operative results, which concluded clinical symptoms and endocrine exams.</p><p><b>RESULTS</b>The follow-up time was from 4 months to 3 years. All patients' symptoms of Cushing syndrome were relieved in 6 months after operation. The endocrine exam was normal in one case and obvious improved in the other four cases. Up to now, one patient drop out of the follow-up, the other 4 cases had no evidence of recurrence.</p><p><b>CONCLUSION</b>PPNAD is a rare type of Cushing syndrome. Diagnose depends on endocrine exams and pathological results. Operation is the effective method for the disease.</p>

The analysis of the factors for postoperative blood pressure recovery of aldosterone producing adenoma patients / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the factors regarding the recovery of postoperative blood pressure of aldosterone producing adenoma (APA) patients.</p><p><b>METHODS</b>Sixty-eight patients with APA were recruited and their data including retinal blood vessel by Doppler sonography, urinary trace albumin, pathological changes of renal biopsy and the adrenal tissues around the adenoma were analyzed in order to determine the correlation between these data and postoperative durative hypertension.</p><p><b>RESULTS</b>Postoperative durative hypertension occurred in 14 cases (41.2%) with increased resistance of unilateral or bilateral central artery of retina, in 16 cases (66.7%) with increased level of urinary trace albumin. Fifteen cases underwent renal biopsy and all of them showed different pathological alterations, 11 cases (73.3%) of which presented with postoperative durative hypertension. The pathological changes of the adrenal tissues around the adenoma is either atrophy or non-atrophy (normal or hyperplasia), 8 cases (40%) and 10 cases (22.2%) of which showed postoperative durative hypertension, respectively.</p><p><b>CONCLUSION</b>The renal pathological changes and increased resistance of retinal blood vessel are the main reasons leading to postoperative hypertension in patients with APA.</p>