A nomogram predicting re-operation due to secondary hemorrhage after monopolar transurethral resection of prostate.

We aim to develop a nomogram to predict re-operation due to secondary hemorrhage after Monopolar transurethral resection of the prostate (M-TURP). We identified patients undergoing M-TURP at Peking University First Hospital from 2000 to 2013. Univariate and multivariate logistic regression models were developed to predict the occurrence re-operation due to secondary hemorrhage. The discriminatory ability of the nomogram was tested using the area under the receiver operating characteristic curve (ROC), and internal validation was performed via bootstrap resampling. Of the 1901 patients who underwent M-TURP during the study period, 9.1% (173 patients) experienced hemorrhage after M-TURP, and they had a 22.0% re-operation rate (38 patients). Benign prostatic hyperplasia (BPH)-related complications (odds ratio, 0.386; 95% CI, 0.177-0.841), percent of resected prostate (OR, 0.156; 95% CI, 0.023-1.060) and suprapubic cystostomy (OR, 0.298; 95% CI, 0.101-0.881) were independently associated with re-operation. The nomogram accurately predicted re-operation (area under the ROC curve 0.718). The negative predictive value was 88.0%, while the positive predictive value was 47.9%. Re-operation due to secondary hemorrhage after M-TURP was associated with no BPH-related complications, lower percent of resected prostate and no suprapubic cystostomy and was accurately predicted with using the nomogram.

Suprapubic cystostomy versus nonsuprapubic cystostomy during monopolar transurethral resection of prostate: a propensity score-matched analysis.

We aim to reassess the safety of the monopolar transurethral resection of the prostate (M-TURP) without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit (10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively) were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier (4.6 days vs 5.2 days), required shorter postoperative stays in the hospital (5.1 days vs 6.0 days), and were at lower risk of operative complications (5.7% vs 9.2%), especially bleeding requiring blood transfusion (2.9% vs 6.1%). Similar findings were observed in cohorts of prostates of 30-80 ml and prostates >80 ml. Furthermore, among patients with a resection weight >42.5 g or surgical time >90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.

Correlation of benign prostatic obstruction-related complications with clinical outcomes in patients after transurethral resection of the prostate.

We aim to investigate the correlation of benign prostatic obstruction (BPO)-related complications with clinical outcomes in patients after transurethral resection of the prostate in China. We reviewed the medical history of all patients who underwent surgery from 1992 to 2013. We assessed the preoperative clinical profile, clinical management, and operative complications. Overall, 2271 patients were enrolled in the study. Of these patients, 1193 (52.5%) had no BPO-related complications and 1078 (46.3%) had BPO-related complications. Compared with patients without BPO-related complications, those with BPO-related complications were older (p = 0.001) and usually had other urologic comorbidities (p = 0.003). Additionally, they tended to have more tissue resected (p < 0.001), a higher American Society of Anesthesiologists grade (p = 0.002), and larger prostates (p < 0.001). Nonetheless, there was no obvious difference in surgical complications between both groups (p > 0.05). Among patients with BPO-related complications, compared with the bladder stone group, only the bladder stone+ group tended to have a greater urinary infection risk after transurethral resection of the prostate. Compared with patients with one or two BPO-related complications, those with three BPO-related complications tended to have a higher risk of pulmonary embolism and acute coronary syndrome (p < 0.05). Despite the widespread use of medication, patients with BPO-related complications were older and had larger prostates; however, transurethral resection of the prostate is still considered a safe and recommended surgical treatment. Nevertheless, those with three or more complications were at a higher risk of severe complication after surgery, and active surgical intervention is needed once BPO-related complications develop.

Correlation of ASA Grade and the Charlson Comorbidity Index With Complications in Patients After Transurethral Resection of Prostate.

OBJECTIVE: To re-assess the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists Physical Status Classification System (ASA grade) as predictive factors of complications after transurethral resection of prostate. METHODS: This study retrospectively included and analyzed consecutive patients undergoing transurethral resection of the prostate at Peking University First Hospital between 1992 and 2013. A multivariate analysis was conducted to evaluate the connection of the ASA and CCI grades with the incidence of complications. RESULTS: This paper studied 2326 cases in total. The CCI and ASA grades were significantly correlated, with a Spearman ρ of 0.245 (P <.001). No considerable differences among the patient cohorts with different CCI or ASA grades were observed in terms of day of catheter removal, surgical time, and prostate size. In addition, no considerable differences were observed in the different modified Clavien classification system scores of complications among patient cohorts with different grades of CCI. CONCLUSION: The majority of complications (86.9%) were of grades I, II, and III, whereas grade IV was less frequent (12.1%), and, after transurethral resection of the prostate, grade V was rare (1%). Males with an ASA grade ≥3 and higher CCI scores were more likely to demonstrate a higher incidence of morbidity than males with a lower grade. However, ASA grades and CCI scores were not independent predictors of complications because of the experience of the surgeon and progress in perioperative management and operative techniques. Therefore, for patients with more comorbidities and higher CCI scores or ASA grades, active surgical intervention is still suggested.

[Diagnosis and treatment of retroperitoneal fibrosis: report of 26 cases].

OBJECTIVE: To evaluate and improve the diagnosis and surgical treatment of the retroperitoneal fibrosis (RPF). METHODS: The medical records of 26 patients with the RPF (21 men and 5 women with mean age 54 years) were analyzed retrospectively. They were been treated from January 1996 to May 2007. Fourteen cases received double-J inter-ureter drainage or pricking pyelostomy and 9 of 15 cases who received open surgery were performed bilateral ureterolysis with their ureters translocated intraperitoneally. RESULTS: For masses in retroperitoneal space, the diagnostic rate of B mode ultrasonography, CT and MRI was 12% (3/26), 86% (18/21) and 57% (8/14) respectively. The patients were followed up from 1 to 106 months. After drained by double-J inter-ureter stent or pricking pyelostomy, the mean serum creatinine level decreased from 373.9 micromol/L to 157.1 micromol/L of 14 patients. Those patients who underwent ureterolysis with ureteral intraperitoneal translocation had good results and their mean serum creatinine level decreased from 171.0 micromol/L before operation to 139.6 micromol/L after operation. Four patients had normal B-ultrasound and intravenous urogram findings with at least 24 months of follow-up. CONCLUSIONS: CT scan has better accuracy for diagnosis of the RPF than B mode ultrasonography and MRI. Prompt and appropriate relief of urinary obstruction with surgical intervention can effectively protect the renal function in patients with the RPF, and the ureterolysis with ureteral intraperitoneal translocation is an effective surgical procedure to treat this disease.

[Expression of ZNRD1 protein in human renal cell carcinoma].

OBJECTIVE: To investigate the expression of zinc ribbon domain-containing1 (ZNRD1) in human renal cell carcinoma and normal kidney tissues. METHODS: The expression of ZNRD1 protein was examined by immunohistochemical staining in 71 renal cell carcinomas and 24 samples of normal kidney tissue. The correlation between the expressions of ZNRD1 protein and clinicopathologic features was analyzed. The expression of ZNRD1 mRNA and ZNRD1 protein was detected by quantitative reverse transcriptase-polymerase chain reaction (PT-PCR) and Western blot in 20 renal cell carcinomas and corresponding adjacent non-cancerous tissues. RESULTS: ZNRD1 protein was detected mostly in the cell nuclei by immunohistochemistry. The positive expression rate of ZNRD1 protein was 91.7% (22/24) in renal cell carcinomas and 20.8% (5/24) in the normal kidney tissues, with a statistically significant difference between cancer and normal kidney tissue (P < 0.01). However, no significant correlation was observed between ZNRD1 protein expression level and clinicopathologic features (P > 0.05). ZNRD1 mRNA expression level was significantly higher in renal cell carcinomas (0.6186) than that in the normal kidney tissues (0.4273) assessed by RT-PCR (P < 0.01). The expression level of ZNRD1 protein by Western blot was 0.5623 in renal cell carcinomas, significantly higher than that in normal kidney tissues (0.3885, P < 0.01). CONCLUSION: ZNRD1 gene and ZNRD1 protein may play an important role in the carcinogenesis of renal cell carcinoma. Further investigation is still needed.

[The effect of Yunnan Baiyao on reduction of intra-operative bleeding of the patients undergoing transurethral resection of prostate].

OBJECTIVE: To investigate the effect of Yunnan Baiyao on reduction of intra-operative bleeding of the patients undergoing transurethral resection of prostate (TURP). METHODS: A randomized placebo-control double-blind multi-center trial was conducted. 203 patients with benign prostate hyperplasia (BPH), aged 50 - 80, who were to undergo TURP were randomly divided into 2 groups: Yunnan Baiyao group, given 500 mg Yunnan Baiyao four times daily since the third day before the operation for 3 days, and placebo group, given empty capsules for 3 days. The amount of intra-operative bleeding, bleeding index and bleeding intensity were compared. The side effect of Yunnan Baiyao was also evaluated. RESULTS: The amount of intra-operative bleeding of the Yunnan Baiyao group was 147 ml +/- 144 ml, significantly less than that of the control group (182 ml +/- 157 ml, P < 0.05). The amount of intra-operative bleeding of the per protocol (PP) population in the Yunnan Baiyao group (n = 58) was 146 ml +/- 116 ml, significantly less than the PP population in the control group (n = 66) (220 ml +/- 207 ml, P = 0.0361). When the weight of the resected prostate tissue was more than 20 gram, the amount of intraoperative bleeding, bleeding index, and bleeding intensity of the ITT population in the Yunnan Baiyao group (n = 60) were all significantly lower than those of the ITT population in the control group (n = 68) (all P < 0.05); the bleeding intensity of the PP population in the Yunnan Baiyao group was 2.4 ml/min +/- 1.8 ml/min, significantly lower than that of the PP population in the control group (3.6 ml/min +/- 3.7 ml/min, P = 0.0072); the bleeding index of the PP population in the Yunnan Baiyao group was 4.7 ml/g +/- 4.6 ml/g, significantly lower than that of the PP population in the control group (7.1 ml/g +/- 8.3 ml/g, P = 0.025). No side effect was found in the 2 groups. CONCLUSION: Yunnan Baiyao is effective on reducing the amount of intraoperative bleeding of TURP without side effect.

[Expression of nucleosomal binding protein 1 in normal prostate benign prostate hyperplasia, and prostate cancer and significance thereof].

OBJECTIVE: To investigate the expression of nucleosomal binding protein 1 (NSBP1) in normal prostate (NP), benign prostate hyperplasia (BPH), and prostate cancer (PCa) and significance thereof. METHODS: Western blotting was used to detect the expression of NSBP1 in 10 specimens of NP from voluntary donors who died of accidents, and 15 specimens of PCa resected during operation. Immunohistochemistry was used to detect the NSBP1 expression in 19 specimens of NP resected during complete cystectomy from patients with bladder carcinoma, and 26 specimens of BPH and 40 specimens of PCa, all resected during operation. RESULTS: Western blotting showed that the relative optical density (OD) of NSBP1 in the PCa tissue was 0.66 +/- 0.02, significantly higher than that of the NP tissue (0.26 +/- 0.03, t = 37.308, P < 0.01). Immunohistochemistry showed that the positive and weak positive rates of protein expression of NSBP1 in the PCa tissue was 80.0% (32/40), significantly higher than those of the NP tissue (36.8%, 7/19) and BPH (34.6%, 9/26) (t = -3.569 and t = -4.152, both P < 0.01). The NSBP1 expression level in the PCa tissue was not correlated with the pathological staging, grade, and serum prostate-specific antigen (P = 0.911, 0.666, and 0.779). CONCLUSION: Highly expressed in the PCa tissue, NSBP1 protein is may be involved in the carcinogenesis of PCa.

[Prediction of the stage of patients with prostate cancer by the combination of serum prostate specific antigen and Gleason score].

OBJECTIVE: To explore the method of predicting the stage of prostate cancer with serum prostate-specific antigen (PSA) and pathological grade. METHODS: One hundred and eighty-seven patients were studied retrospectively with prostate cancer diagnosed by systemic biopsy in our hospital. The rank correlation analysis, rank sum test and stepwise discriminant multivariate analysis were used to assess the correlation of serum PSA level, ratio of free PSA to total PSA (FPSA/TPSA ratio) with Gleason score (GS) and stage. RESULTS: Serum PSA level increased with GS for prostate cancer patients (r = 0.369, P < 0.001). With increasing stage, serum PSA level and GS increased (r = 0.398, 0.530, P < 0.001). Overall, FPSA/TPSA ratio was not correlated with stage (P > 0.70), but a significant negative correlation was demonstrated between them when serum PSA < or = 10 microg/L (r = -0.600, P < 0.05). When serum PSA > 20 microg/L, 67% - 87% patients with prostate cancer may be stage C or D. The equation using serum PSA and GS to predict the stage of patients with prostate cancer was: x = -3.488 + 0.041 x PSA + 0.428 x GS. CONCLUSIONS: Serum PSA level is positively correlated with GS for prostate cancer patients. Serum PSA level and GS are positively correlated with stage. A negative correlation between FPSA/TPSA ratio and stage is demonstrated when serum PSA < or = 10 microg/L. The combination of serum PSA and GS may predict the stage of patients with prostate cancer.

[Diagnosis and management of primary hyperparathyrodism with urolithiasis].

OBJECTIVE: To investigate the diagnosis and management of primary hyperparathyroidism with urolithiasis. METHODS: The clinical data of 12 patients who were diagnosed with primary hyperparathyroidism with urolithiasis from January 1998 to June 2004 were analyzed retrospectively. RESULTS: Four male and five female patients were demonstrated pathologically as parathyroid adenoma, with a mean age of 45.7 +/- 11.8 years (26 approximately 57) and a stone history of 8.3 +/- 6.4 years (0.5 approximately 22). Their serum calcium and PTH level were elevated obviously, while serum phosphate of 66% patients were lowered. The positive rate and accuracy of ultrasound, CT and (99m)TC-MIBI imaging were 67%, 100%, and 100% and 67%, 75%, 100% respectively. After resection of the parathyroid adenoma, the patients' serum calcium and PTH returned to normal. The other data of 3 cases without parathyroid adenoma. all males aged 45 approximately 54, were also investigated. CONCLUSIONS: Serum calcium level above 2.96 mmol/L and PTH 3.9 or more times as normal in patients with recurrent or bilateral urolithiasis should be suspected with primary hyperparathyroidism. (99m)TC-MIBI image functions best in preoperative localization of the abnormal gland. Parathyroidectomy is the curative approach for the disease. Stones should be followed up after operation and appropriate treatment should be employed when needed.

[Clinical analysis of 174 cases of primary ureteral carcinoma].

OBJECTIVE: To analyse the clinicopathological features and discuss the diagnosis, therapy and prognosis of primary ureteral carcinoma. METHODS: One hundred and seventy four cases of primary ureteral carcinoma diagnosed pathologically between January 1971 and July 2002 in our institution were followed up and retrospectively studied. RESULTS: The incidence of primary ureteral carcinoma was increasing during the last 30 years. The mean age of occurrence was 63.7 years. The most useful methods of detecting tumors preoperatively were retrograde urogram, CT, magnetic resonance urography and ureteroscopy, with positive percentage of 87.8% (86/98), 96.0% (48/50), 95.8% (23/24), 87.0% (20/23) respectively. 131 (75.3%) cases underwent nephroureterectomy with a cuff of bladder. 171 (98.3%) cases were transitional cell carcinoma. T(a-2) and G(1, 2) tumors account for 70% of all respectively. The 5 year and 10 year survival rates were 53.1% (52/98) and 30.5% (18/59) respectively. The subsequent bladder cancer occurred in 38 cases (23.8%), and the subsequent contralateral ureteral carcinoma occurred in 6 cases (3.8%). CONCLUSIONS: The prognosis of primary ureteral carcinoma is poor. Tumor stage and grade are both the prognostic factors. Precise preoperative diagnosis and more effective adjuvant therapy may improve the prognosis.

[Prevention of postoperative recurrence of human bladder carcinoma by intravesical instillation of immunotoxin, a clinical study].

OBJECTIVE: To observe the effects of intravesical instillation of immunotoxin (IT) on the prevention of recurrence of bladder carcinoma. METHODS: 128 patients with superficial bladder carcinoma or bladder carcinoma of T2 stage underwent operation, and then were randomly divided into 3 groups 2 - 3 weeks after operation to be instilled intravesically with solution of mitomycin (n = 53), Calmette-Guerin vaccine (n = 30), or IT (n = 45) once a week for 8 weeks and then once every month for 8 months respectively. Cystoscopy, blood routine examination, routine urine examination, and liver function test were conducted every 3 months. Immunohistochemistry was used to examine 30 samples of resected carcinoma. The effects and side effects were observed. Recurrence was verified by cystoscopy and/or ultrasonography, CT, and surgery. RESULTS: Out of the 30 samples of resected bladder carcinoma, 27 were staining positive (+ - + + +) with a positive rate of 90%. The binding activity was significantly different between the G(1) carcinoma of and the G(3) carcinoma (P < 0.05) and not significantly different between the G(1) and G(2) carcinomas and between the G(2) and G(3) carcinomas (both P > 0.05). The higher the grade of carcinoma, the stronger the binding activity of IT (P < 0.05). The recurrence rate in the first year were 11.1%, 10.0%, and 15.1% in the IT, BCG, and MMC groups respectively without significant difference between any 2 groups (all P > 0.05); and the recurrence rate in the 2nd year were 24.4%, 30.0%, and 28.3% in the 3 groups respectively without significant difference between any 2 groups (all P > 0.05). The side effect rate were 17.8% on the IT group, significantly lower than those in the other 2 groups (70.0% and 56.6% respectively, both P < 0.01). However, the side effect rates between the BCG group and MMC group was not significantly different (P > 0.05). CONCLUSION: IT is more effective on the prevention of recurrence of carcinomas with higher malignancy and has fewer side effects. The short-term effect of IT is similar to those of BCG and MMC. The activity of IT is associated with the grade and not the stage of carcinoma.