Endourological treatment of aged high-risk patients with benign prostate hyperplasia: a report of 283 cases / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the safety and effectiveness of endourological techniques in the treatment of benign prostate hyperplasia (BPH) in aged high-risk patients.</p><p><b>METHODS</b>We used endourological techniques in the treatment of 283 BPH patients aged over 70 years and complicated with hydronephrosis, renal failure, heart failure, cerebral infarction, respiratory dysfunction, anemia, diabetes, bladder tumor, or prostate weight over 80 g, TURP (transurethral resection of the prostate) for 112 cases and PKRP (transurethral plasmakinetic resection of the prostate) for the other 171. All the patients were followed up for 1-30 months.</p><p><b>RESULTS</b>In the TURP group, the scores on IPSS and QOL were decreased from 27.5 +/- 2.8, 5.5 +/- 1.0 to 5.8 +/- 1.2, 1.0 +/- 0.5, and the residual urine volume (RUV) from (75.0 +/- 20.0) ml to (8.0 +/- 3.0) ml, but the maximal flow rate (Qmax) increased from (6.5 +/- 2.0) ml/s to (18.5 +/- 1.5) ml/s (P < 0.05), while in the PKRP group, the scores on IPSS and QOL were decreased from 28.2 +/- 2.2, 5.5 +/- 1.0 to 5.4 +/- 1.6, 1.0 +/- 0.5, and RUV from (80.0 +/- 20.0) ml to (7.0 +/- 3.0) ml, and Qmax increased from (6.8 +/- 2.1) ml/s to (20.0 +/- 1.5) ml/s (P < 0.05). There were no statistically significant differences in IPSS, QOL, Qmax and RUV after treatment between the two groups (P > 0.05), but significantly less complications were found in the PKRP than in the TURP group (P < 0.05).</p><p><b>CONCLUSION</b>Endourological treatment, especially PKRP, with comprehensive perioperative preparations, unerring operative skills, well-controlled operation time, and intensive postoperative monitoring and nursing, has the advantages of high safety, less bleeding, fewer complications and definite effectiveness for aged high-risk BPH patients.</p>

Efficacy and safety of vardenafil for kidney transplant recipients with erectile dysfunction / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of vardenafil in kidney transplant recipients with erectile dysfunction.</p><p><b>METHODS</b>Thirty-nine kidney transplant recipients with erectile dysfunction (ED) and serum creatinine values <2 mg/dl were enrolled in a 4-week randomized, double blind, placebo-controlled study, 19 treated with placebo and 20 with vardenafil. Vardenafil efficacy was assessed with the IIEF questionnaire after 4 weeks of treatment, and its safety appraised by measuring serum creatinine levels, creatinine clearances and cyclosporine concentrations before and after the treatment.</p><p><b>RESULTS</b>IIEF scores improved from 12.6 +/- 3.4 to 26.5 +/- 2.8 (P < 0.01), but renal function and cyclosporine concentrations remained unchanged in the vardenafil-treated patients. Adverse effects were observed in 4 patients: headache in 2, palpitation and flush in 1, and dyspepsia in the other.</p><p><b>CONCLUSION</b>Oral vardenafil therapy has a high efficacy and a low incidence of adverse events for kidney transplant recipients with ED.</p>

CXCR4 combined with P504S or P63 in differential diagnosis of benign and malignant prostatic diseases / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the application of CXC chemokine receptor-4 (CXCR4) combined with alpha-methylacyl-CoA racemase (P504S) or P63 protein in the differential diagnosis of benign and malignant prostatic diseases.</p><p><b>METHODS</b>The EnVision immunohistochemical method was used to detect the expressions of CXCR4, P504S and P63 protein in 40 specimens of PCa not treated by any anticancer therapy and 30 specimens of BPH tissues. The correlation was analyzed between CXCR4 expression and the characteristics of PCa metastasis.</p><p><b>RESULTS</b>Of the 40 cases of PCa, 33 (82.5%) were stained positive for CXCR4, 37 (92.5%) for P504S and 2 (5%) for P63 protein. Of the 30 cases of BPH, 5 (16.6%) exhibited positivity for CXCR4, 1 for P504S and all for P63. P504S + P63 showed a higher rate of correct diagnosis of PCa than either CXCR4 + P63 or P504S + CXCR4. There was a statistically significant correlation between CXCR4 expression and cancer metastasis (P < 0.05).</p><p><b>CONCLUSION</b>P504S, CXCR4 and P63 are useful tumor markers for the diagnosis and differentiation of benign and malignant prostatic diseases. CXCR4 gives a high rate of correct diagnosis when combined with P504S or P63, and has an important application value in the differential diagnosis of benign and malignant prostatic diseases.</p>

Morphological changes of cholinergic nerve fibers in the urinary bladder after establishment of artificial somatic-autonomic reflex arc in rats / 神经科学通报·英文版

<p><b>OBJECTIVE</b>To establish an artificial somatic-autonomic reflex arc in rats and observe the following distributive changes of neural fibers in the bladder.</p><p><b>METHODS</b>Adult Sprague-Dawley rats were randomly divided into three groups: control group, spinal cord injury (SCI) group, and reinnervation group. DiI retrograde tracing was used to verify establishment of the model and to investigate the transport function of the regenerated efferent axons in the new reflex arc. Choline acetyltransferase (ChAT) in the DiI-labeled neurons was detected by immunohistochemistry. Distribution of neural fibers in the bladder was observed by acetylcholine esterase staining.</p><p><b>RESULTS</b>DiI-labeled neurons distributed mainly in the left ventral horn from L3 to L5, and some of them were also ChAT-positive. The neural fibers in the bladder detrusor reduced remarkably in the SCI group compared with the control (P < 0.05). After establishment of the somatic-autonomic reflex arc in the reinnervation group, the number of ipsilateral fibers in the bladder increased markedly compared with the SCI group (P < 0.05), though still much less than that in the control (P < 0.05).</p><p><b>CONCLUSION</b>The efferent branches of the somatic nerves may grow and replace the parasympathetic preganglionic axons through axonal regeneration. Acetylcholine is still the major neurotransmitter of the new reflex arc. The controllability of detrusor may be promoted when it is reinnervated by the pelvic ganglia efferent somatic motor fibers from the postganglionic axons.</p>

Anorectal functions in patients with lumbosacral spinal cord injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the anorectal status in patients with lumbosacral spinal cord injury (SCI).</p><p><b>METHODS</b>Twenty six patients (23 males, 3 females) with lumbosacral SCI and 13 normal volunteers were enrolled into this study as controls. The median age was 43.7 years (ranging 17-68 years) and the median time of patients since injury was 59.1 months (ranging 8 months-15 years). They were diagnosed as complete lumbosacral SCI (n =2, American Spinal Injury Association (ASIA) score A), or incomplete lumbosacral SCI (n=24, ASIA score B-D) with mixed symptoms of constipation and/or fecal incontinence, and were studied by anorectal manometry. None of the patients had any medical treatments for neurogenic bowel prior to this study.</p><p><b>RESULTS</b>The maximum anal resting pressure in lumbosacral SCI patients group was slightly lower than that in control group (One-way ANOVA: P=0.939). During defecatory maneuvers, 23 of 26 (88.5%) patients with lumbosacral SCI and 1 of 13 (7.7%) in the control group showed pelvic floor dysfunction (PFD) (Fisher's exact test: P<0.0001). Rectoanal inhibitory reflex (RAIR) was identified in both patients with lumbosacral SCI and the controls. The rectal volume for sustained relaxation of the anal sphincter tone in lumbosacral SCI patients group was significantly higher than that in the control group (Independent-Samples t test: P<0.0001). The mean rectal volume to generate the first sensation was 92.7 ml+/-57.1 ml in SCI patients, 41.5 ml+/-13.4 ml in the control group (Independent-Samples t test: P<0.0001).</p><p><b>CONCLUSIONS</b>Most of the patients with lumbosacral SCI show PFD during defecatory maneuvers and their rectal sensation functions are severely damaged. Some patients exhibit abnormal cough reflex. Anorectal manometry may be helpful to find the unidentified supraconal lesions. RAIR may be modulated by central nervous system (CNS).</p>

Role of MAPK signal transduction pathway phosphorylation induced by granulocyte-macrophage-colony stimulating factor in the proliferation of hormone-independent prostate cancer / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the phosphorylation intensity of MAPK pathway molecular Erk1/2 and the proliferation of prostate cancer cell line PC-3M.</p><p><b>METHODS</b>Flow cytometry and RT-PCR were employed to study the ratio of different cell cycles and phases, respectively, before and after GM-CSF stimulation. Erk1/2 phosphorylation intensity was examined by Western blot simultaneously.</p><p><b>RESULTS</b>The rate of PC-3M cells at S and G2/M stages and the expression intensity of Ki-67 increased after GM-CSF incubation in a dose-dependent manner. The phosphorylation intensity of Erk1/2 increased remarkably after stimulation with GM-CSF.</p><p><b>CONCLUSION</b>The intensification of Erk1/2 phosphorylation is one important molecular mechanism of the proliferation of hormone-independent prostate cancer.</p>

Electrophysiological monitoring and identification of neural roots during somatic-autonomic reflex pathway procedure for neurogenic bladder / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To identify and separate the ventral root from dorsal root, which is the key for success of the artificial somatic-autonomic reflex pathway procedure for neurogenic bladder after spinal cord injury (SCI). Here we report the results of intra-operating room monitoring with 10 paralyzed patients.</p><p><b>METHODS</b>Ten male volunteers with complete suprasacral SCI underwent the artificial somatic-autonomic procedure under general anesthesia. Vastus medialis, tibialis anticus and gastrocnemius medialis of the left lower limb were monitored for electromyogram (EMG) activities resulted from L4, L5, and S1 stimulation respectively to differentiate the ventral root from dorsal root. A Laborie Urodynamics system was connected with a three channel urodynamic catheter inserted into the bladder. The L2 and L3 roots were stimulated separately while the intravesical pressure was monitored to evaluate the function of each root.</p><p><b>RESULTS</b>The thresholds of stimulation on ventral root were 0.02 ms duration, 0.2-0.4 mA, (mean 0.3 mA+/-0.07 mA), compared with 0.2-0.4 ms duration, 1.5-3 mA (mean 2.3 mA+/-0.5 mA) for dorsal root (P<0.01) to cause revoked potentials and EMG. Electrical stimulation on L4 roots resulted in the EMG being recorded mainly on vastus medialis, while stimulation on L5 or S1 roots caused electrical activities of tibialis anticus or gastrocnemius medialis respectively. The continuous stimulation for about 3-5 seconds on S2 or S3 ventral root (0.02 ms, 20 Hz, and 0.4 mA) could resulted in bladder detrusor contraction, but the strongest bladder contraction over 50 cm H2O was usually caused by stimulation on S3 ventral root in 7 of the 10 patients.</p><p><b>CONCLUSIONS</b>Intra-operating room electrophysiological monitoring is of great help to identify and separate ventral root from dorsal root, and to select the appropriate sacral ventral root for best bladder reinnervation. Different parameters and thresholds on different roots are the most important factors to keep in mind to avoid damaging the roots and to assure the best results.</p>

Ureteroscopic holmium: YAG laser lithotripsy for managing urinary tract calculi / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness and safety of ureteroscopic holmium: YAG laser lithotripsy for managing ureteral calculi.</p><p><b>METHODS</b>Ureteroscopic holmium: YAG laser lithotripsy was used in 168 ureteral calculi (proximal 27 cases, middle 33 cases, distal 108 cases). Transurethral cystoscopic holmium: YAG laser lithotripsy in 12 bladder calculi.</p><p><b>RESULTS</b>Four to six weeks after operation, The stone-free rate was 93% (25/27) in the proximal ureteral calculi, 94% (31/33) in the middle ureteral calculi, 94% (102/108) in the distal ureteral calculi, respectively. The complication rate was 5% (8 cases). the stone-free rate of bladder calculi was 100% (12/12), no complication.</p><p><b>CONCLUSION</b>Ureteroscopic holmium: YAG laser lithotripsy is a highly effective and safe treatment modality for managing ureteral calculi.</p>

The application of complexed PSA and its relative indexes in the diagnosis of prostate cancer / 中华男科学杂志

<p><b>OBJECTIVES</b>To investigate the applicable value of complexed prostate-specific antigen (PSA) in the diagnosis of prostate cancer.</p><p><b>METHODS</b>From July 2001 to May 2002, 152 consecutive patients (21 were prostate cancer and 131 were benign prostate hyperplasia proved by pathologic diagnosis) whose serum total PSA (TPSA) ranged from 0.2 microgram/L to 21.9 micrograms/L were accessed. The measurement of total PSA, free PSA (FPSA) and complexed PSA was performed by chemiluminescence immuno-assay method. The correlation of TPSA and CPSA was analysed by SPPS 10.0. The receiver operating characteristic curves were generated by plotting the sensitivity versus specificity.</p><p><b>RESULTS</b>Area under the curve was calculated for each assay. Logistic regression analysis was used to evaluate the ability of CPSA, TPSA and FPSA/TPSA. Area under the ROC curve of CPSA, TPSA and FPSA/TPSA ratio were 0.811, 0.799 and 0.376, respectively. The specificity for the complexed PSA, TPSA and FPSA/FPSA ratio were 62%, 57% and 4.7%, respectively, at cutoffs yielding 95% sensitivity. CPSA was determined to be the best index among the three ones by logistic regression analysis.</p><p><b>CONCLUSIONS</b>The CPSA and TPSA level in serum may provide good differentiation effect of prostate cancer and benign prostate hyperplasia than FPSA/TPSA ratio. The CPSA performs better than TPSA. At the same sensitivity, CPSA has higher specificity.</p>