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Objective:To investigate the effect of transurethral plasma enucleation of prostate with bladder neck and prostatic apex urethral mucosa preservation on the incidence of retrograde ejaculation after surgery.Methods:The clinical data of 77 patients with benign prostatic hyperplasia (BPH) admitted to Jinhua people's Hospital from January 2018 to June 2020 were retrospectively analyzed. The ages of the two groups [(62.06±2.01)years old and (62.36 ± 2.12)years old] were comparable. There were no significant differences between the groups( P>0.05) in term of the prostate volume (72.91±17.57) ml vs. (68.07±17.28)ml, Q max [(7.33±2.02)ml/s vs. (7.79±2.09)ml/s)], and IPSS (25.51±5.66) vs.(25.17±4.90). The conventional operation group was treated with " trefoil" enucleation of prostate. The modified operation group underwent the following three improved techniques. Firstly, the anterior mucosa of the verumontanum was cut 1.5 cm away from the medial surface of the verumontanum to prevent the external sphincter injury. Secondly, part of the prostate tissue was retained by exceeding the verumontanum when cutting off the bilateral lobes. Thirdly, the middle lobe of the prostate was bluntly stripped to the bladder neck with the sheath of the electroscope in order to protect the transverse muscle fibers as well as the integrity of the bladder neck. The outcome and the ejaculation function of the two groups were analyzed. Results:There was no significant difference in operation time [(66.74±9.29)min vs. (71.29±15.32) min], catheter indwelling duration [(5.31±0.76)d vs.(5.00±1.06)d], and hospital stay [(7.57±0.88) d vs. (7.17±1.45)d] between the two groups ( P>0.05) after more than 6 months of follow-up. According to IIEF score, mild erectile dysfunction occurred in both groups, with the incidence rate of 20.7%(6/29) and 13.5%(5/37) respectively, and there was no significant difference between the two groups ( P>0.05). The postoperative maximum urinary flow rate (Q max) [(23.51±4.25) ml/s vs.(24.05±3.81)ml/s] and IPSS score (6.46±2.72 vs. 6.55±2.99) was significantly different from that before the operation ( P<0.05). However, there was no significant difference between the two groups ( P>0.05). The incidence of retrograde ejaculation in conventional operation group and modified operation group was 23/35(65.7%) and 13/42(31.0%), and the difference was statistically significant ( P<0.05). Immediate urinary continence were 24/35(68.6%) and 36/42(85.7%) in the conventional operation group and the modified operation group respectively, and there was no significant difference between the two groups( P>0.05). After 6 months of follow-up, urinary continence in both groups was 100.0%. Conclusions:Transurethral plasmakinetic enucleation of the prostate with the preservation of bladder neck and urethral mucosa of prostate apex is the same effective as conventional operation in the treatment of benign prostatic hyperplasia, but the incidence of retrograde ejaculation after operation is significantly reduced, which is suitable for those patients who desire to retain their ejaculation function.
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Objective To explore the application and early efficacy of modified Veil nerve-sparing technique during laparoscopic radical prostatectomy(LRP).Methods Fifty-seven modified Veil nerve-sparing during LRP procedures were performed in patients with clinically localized prostate cancer between 2012 and 2016 by the same surgeon.Preoperative PSA level was 10.9 μg/ml,and Gleason score was 6.06(5-8).TNM clinical stage showed cT1 in 39 cases and cT2in 18 cases.All patients underwent transrectal ultrasonography before operation. Prostate volume was 40.2 (26- 99) ml. ECT bone scan excluded bone metastasis.MRI or CT examination showed no obvious prostate invasion and lymph node metastasis. The key technology was anatomical separation of detrusor apron, dorsal vascular complex (DVC) and the level between the prostate capsule, and a complete reservation was accomplished. Measurements: the rates and location of positive surgical margins (PSM) and tumor biochemical recurrence rate as well as functional outcomes were presented.Questionnaires were used to assess urine function and IIEF-5 score was used to estimate sexual function.Results Fifty-seven cases were followed up,and the average follow-up of 27.3(6-65)months.Five cases showed biochemical recurrence after 23 months.Five patients had a PSM(2 patients in apical margins,1 patient in left side,1 patient in right side and 1 patient in the bottom).At catheter removal,49 of 57 patients(86%)were dry(0 pads),and 8 of 57 patients(14%)needed one security pad.After 3 months and 6 months,42%(24 of 57 patients)and 60%(34 of 57 patients)presented an International Index of Erectile Function score>15(with or without phospho-diesterasetype-5inhibitors). Conclusions The modified Veil nerve-sparing technique during LRP can retain the fascia around the prostate more completely and restore postoperative urine and erectile function early.For selective cases, it will not increase the positive rate of surgical margins and biochemical recurrence rate.
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Objective To analyze the fetus chromosome abnormalities in women with advanced maternal age under the universal two-child policy. Methods A total of 10607 women underwent prenatal diagnosis proce-dures from the year of 2015 to 2016,among which 3569 cases were with advanced maternal age. Cytogenetic karyotyping was conducted with chromosomal microarray analysis(CMA)in 854 cases. The ration of chromosome abnormalities in the two population groups(aged from 35~39 and over 40)were counted. The type of abnormali-ties were also analyzed. Results The ration of women with advanced maternal age in 10607 cases underwent pre-natal diagnosis between 2015 and 2016 was 33.6%. The respective rations were 27.2%and 37.9%. The detection rates of chromosome abnormalities were 7.9% and 10.8%,with significantly difference. The significant differences were also found in the detection rate of chromosome aneuploidies ,but no differences in other chromosome abnor- malities. CMA was benefit to detect the micro chromosome abnormalities. Conclusions In 2016,the number of prenatal diagnosis procedures increased under the two-child policy. The detection rate of chromosome abnormalities also significantly increased. The incidence of chromosome abnormalities was higher with the growing age of preg-nant women. Genetic counseling must be presented and prenatal diagnosis should be promoted in women with ad-vanced age.
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Objective To analyze oncological outcomes of 125I permanent implant brachytherapy (125I-PIB) in clinically localized prostate cancer. Methods Between June 2008 and June 2015, 121 patients with clinically localized prostate cancer were treated with 125I-PIB, and their average age was 72.37 years old. Before treatment, the average prostate-specific antigen (PSA) level was 17.7 ng/ml, prostate volume was (51.4 ±15.0) cm3, the International Prognostic Scoring System (IPSS) score was (21.6 ±2.4) scores. The intermediate-risk and high-risk patients were treated with adjuvant endocrine or supplemental external beam radiotherapy. All patients were followed-up. Biochemical recurrence was defined as the PSA nadir plus 2.0 ng/ml. Results Average follow-up time of the 121 patients was 41.81 months. The prostate volume was (23.1 ± 10.2) cm3, and the IPSS score was (9.7±3.3) scores. Rates of 5-year overall survival, biochemical recurrence-free survival and cancer-specific survival were 86.7 %, 76.7 % and 96.5 %, respectively. 5-year biochemical recurrence-free survival rates were 88.5 %, 67.5 % and 65.2 % in the low-, intermediate-, and high-risk groups, respectively. Biochemical recurrence-free survival did not differ significantly by three risk groups (P=0.103), but the difference between high-risk and low-risk groups was statistically significant (P=0.028). According to multivariate analysis, higher prostate-specific antigen (P=0.021), higher Gleason score (P=0.023) and higher clinical T stage (P=0.037) were the significant covariates associated with biochemical recurrence-free survival. The addition of hormonal therapy or external beam radiation therapy was associated with significantly better outcomes than brachytherapy monotherapy (P=0.036, P=0.027). As for complications, there were 4 cases of surgery (trans-urethral resection of the prostate) and 4 cases of cardiovascular complications. Conclusions The 125I-PIB can bring excellent oncological outcomes and acceptable complications in patients. Adjuvant endocrine or external beam radiotherapy for the intermediate-risk and high-risk patients may improve the outcome. Factors influencing efficacy include the high PSA, Gleason score and clinical T stage.
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Objective To evaluate the efficacy of 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap for the treatment of complex anterior urthral strictures.Methods Between January 2006 and January 2013, 37 patients with complex anterior urethral stricture were treated by 1-stage urethroplasty using pedicle circular fascioctaneous preputial flap.The mean age was 41 years ( 22 -71 years) .The etiology of stricture included trauma of 13 cases, iatrogenieity of 13 cases, gonorrhea infection of 2 cases, unknown reason of 9 cases.The penile urethral stricture was found in 22 cases, the bulbourethral stricture in 9 cases, and stricture extending from penile to posterior urethra in 6 cases.The mean length of anterior urethral stricture was 8.1 cm (range 5.0-14.0 cm).A circumferential island of the preputial/distal penile skin was mobilized by the technique of preserving penile fasciocutaneous wide vascular pedicle. The pedicle is composed of two layers of the dartos and the superficial lamella of Buck′s fascia, and the flap was divided in the midventral/middorsal plane back to the penoscrotal junction to convert the circular configuration to a longitudinal trip for urethral reconstruction.The dorsal and ventral inlaid flap urethroplasty was performed in 27 cases and tubularized flap urethroplasty was performed in 10 cases.Results The mean operative duration was 3.1 h (2.5-3.5 h).The mean length of the circular fascioctaneous preputial flap was 10.4 cm (range 9.0 -14.0 cm).All the patients were followed up for mean 22 months (3 -51 months).Thirty-two cases voided well and the mean peak urinary flow rate was 22.3 ml/s (15.0-29.0 ml/s).One-stage healing achieved in 32 cases (86.5%).Recurrent stenosis was noted in 4 cases, and meatal stenosis occurred in 1 patient, who required re-operation.Re-repair succeeded in 4 cases and total success rate was 97.3% (36/37).Conclusions The pedicle circular fascioctaneous preputial flap has advantage of good blood supply and autograft for new meatus.It could be a reliable and durable method for the treatment of complex anterior urthral strictures(≥5 cm) in 1-stage urethroplasty.
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Objective To evaluate the clinical value of the modified nerve-sparing open antegrade retropubic radical prostatectomy (MNS-ORP).Methods MNS-ORPs were performed in 30 patients with clinically localized prostate cancer.The modified technique included: endopelvic fascia was not incised, the prostate capsule was freed laterally from surrounding fasciae and dorsally;using the method of separating the peripheral fascia of the prostate, the Veil technique was applied to the open operation, that is, the modified Veil perserving nerve technology;pelvic lymph node dissections (9 regions and 5 groups) were extended;bladder neck preservation was completed;deep dorsal vein complex was bunched;jumper intussusception technology was applied for bladder and urethral anastomosis.Functional outcomes of continence and sexual function (IIEF-score) were followed-up.Results Median age of patients was 62 years old, and the level of PSA was 11.9 ng/ml.Median operating time was 150 minutes (75-240 minutes), blood loss was 350 ml (100-1 600 ml), preoperative IIEF-score was 21 scores (15-25 scores).Pathologic stage included pT1 (8 cases), pT2a (15 cases), pT2b (4 cases) and pT3a (3 cases).By Gleason score, there were 2 cases of 5 scores, 7 cases of 6 scores, 20 cases of 7 scores and 1 case of 8 scores.4 cases had positive margins including 2 cases (10.5 ％) of pT2 and 2 cases (67 ％) of pT3.There were no postoperative complications.Mean follow-up was 19 months (6-48 months).At the 1st month, 27 patients (90 ％) got full continence, and at the 3rd month, all of the patients had full continence.At the 3rd month and the 6th month, median IIEF-scores were 13 and 19 scores, respectively with baseline of IIEF-score reaching by 40 ％ (at the 3rd month) and 70 ％ (at the 6th month) of preoperative level.Conclusions MNS-ORP follows rationales of radical prostatectomy and might be considered for selected patients.Preserving all periprostatic fasciae/nerves can recover early continence and maintains potency without affecting outcomes.
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Scutellarin is the main effective constituent of breviscapine, a flavonoid mixture isolated from the dried whole plant of Erigeron breviscapus (Vant.) Hand-Mazz, and valsartan is used as an antihypertensive drug. These two drugs have already been clinically used together to treat diabetic nephropathy (DN) in China, and the combined medications showed some enhanced protection against DN. The aim of this study is to investigate the potential pharmacokinetic interaction between scutellarin and valsartan in rats. Breviscapine injection (20 mg x kg(-1), i.v.) and valsartan (15 mg x kg-, i.g.), either alone or together were given to 18 male Sprague-Dawley rats. Concentrations of scutellarin and valsartan were quantified by HPLC, and pharmacokinetic parameters were calculated by non-compartmental methods. We found that the pharmacokinetic parameters of scutellarin altered significantly after co-administration of oral valsartan. The plasma clearance (CL(p)) and the bile clearance (CL(b)) of scutellarin were reduced significantly in the presence of valsartan. After oral administration of valsartan with or without intravenous scutellarin, however, the pharmacokinetic parameters of valsartan were comparable. In conclusion, our data suggests that the concurrent use of valsartan reduces the biliary excretion of scutellarin, and this may be due to the inhibitory effect of valsartan on the biliary excretion of scutellarin mediated by Mrp2 (Multidrug resistance-associated protein 2).