[One-puncture one-needle TRUS-guided prostate biopsy for prevention of postoperative infections].

OBJECTIVE: To explore the feasibility and effectiveness of "one-puncture one-needle" transrectal ultrasound (TRUS)-guided prostate biopsy in the prevention of postoperative infections. METHODS: We retrospectively analyzed the clinical data about "one-puncture one-needle" (the observation group) and "one-person one-needle" (the control group) TRUS-guided prostate biopsy performed in the Second People's Hospital of Guangdong Province from January 2005 to December 2015, and compared the incidence rates of puncture-related infection between the two strategies. By "one-puncture one-needle", one needle was used for one biopsy puncture, while by "one-person one-needle", one needle was used for all biopsy punctures in one patient and the needle was sterilized with iodophor after each puncture. RESULTS: Totally, 120 patients received 6+1-core or 12+1-core "one-person one-needle" and 466 underwent 12+1-core "one-puncture one-needle" TRUS-guided prostate biopsy. There were no statistically significant differences between the two groups of patients in age, the prostate volume, the serum PSA level, or the detection rate of prostate cancer (P >0.05). Compared with the control group, the observation group showed remarkably lower incidence rates of puncture-related urinary tract infection (7.5% vs 0.9%, P <0.05), fever (5.0% vs 1.1%, P <0.05), bacteriuria (2.5% vs 0.2%, P <0.05), and total infections (16.7% vs 2.6%, P<0.05) postoperatively. Two cases of bacteremia or sepsis were found in each of the groups, with no significant difference between the two. CONCLUSIONS: "One-puncture one-needle" TRUS-guided prostate biopsy can effectively prevent puncture-related infections.

Transurethral front-firing Greenlight bladder autoaugmentation for bladder contracture: technique and clinical outcomes.

OBJECTIVE: To describe a novel transurethral front-firing Greenlight bladder autoaugmentation for the treatment of bladder contracture and report initial clinical outcomes. METHODS: Between April 2014 and August 2015, five patients diagnosed with contracted bladder were all refractory to conservative treatment and received novel transurethral autoaugmentation. CT scan and urodynamics examination were conducted before operation for disease assessment. Mucosal and muscular layers of bladder wall in fundus were incised vertically and horizontally with front-firing Greenlight laser to enlarge bladder capacity in the operation. Imaging examination and periodical urodynamics study were performed to evaluate the clinical outcomes of the procedure in postoperative follow-up. RESULTS: Transurethral front-firing Greenlight bladder autoaugmentation was performed successfully on all the patients. The mean operative time was 59 min (range 52-65 min) with no significant blood loss. Urodynamic parameters of these patients after operation improved significantly compared with those before operation. Average maximum cystometric capacity (Vmax) increased from 91.2 to 333 ml (p < 0.01), average maximum flow rate (Qmax) ascended from 12.6 to 18.62 ml/min (p < 0.01), and average flow rate (Q(ave)) also increased from 5.74 to 13.18 ml/min (p < 0.01). At the last follow-up, all the patients could void spontaneously with good bladder emptying and their symptoms improved significantly. CONCLUSION: Our novel transurethral front-firing Greenlight bladder autoaugmentation is a safe and effective treatment for contracted bladders. Future studies with larger sample size and long-term follow-up are needed to confirm our findings.

[Comparison of the surgical approaches for nephrectomy in living related donors].

OBJECTIVE: To compare the clinical effects and graft outcomes of 4 surgical approaches for nephrectomy in living related kidney donors. METHODS: Between June, 2004 and June, 2007, 119 living related kidney donors underwent nephrectomy via different surgical approaches, and their clinical data were retrospectively analyzed. Of these donors, 22 received retroperitoneal open nephrectomy, 21 had retroperitoneoscopic nephrectomy, 13 had hand-assisted laparoscopic nephrectomy, and 63 underwent transperitoneal open nephrectomy. The operating time, warm ischemia time of the graft, renal graft artery and vein lengths, reduction rate of recipient serum creatinine in the first 3 days after renal transplantation, mean hospital stay and complications of the donors were compared between the 4 surgical approaches. RESULTS: Open surgeries were associated with significantly shorter operating time (P=0.0033) and warm ischemia time of the graft (P=0.0001), longer hospital stay (P=0.0000), higher hospital expenses (P=0.0000), faster postoperative reduction of recipient serum creatinine (P=0.0001), and longer renal artery and vein lengths (P=0.0000 on the left and P=0.0001 on the right) than laparoscopic surgeries. In the laparoscopic surgery group, subcutaneous emphysema occurred in 1 case, DGF in 2 cases, and lumbar vein hemorrhage in 2 cases for which open surgery was performed. In the open surgery group, only one case required reoperation due to adrenal gland hemorrhage. All the kidney grafts were successfully harvested without other complications observed in the donors. CONCLUSIONS: Both open and laparoscopic surgeries are safe for nephrectomy in living related kidney donors, and the selection of the surgical approaches depends on the kidney and donor conditions and the surgical proficiency of the surgeons.

[Effectiveness and significance of prostatic ischemia in rabbit].

OBJECTIVE: To evaluate the effect of prostatic ischemia in rabbit and approach the significance of ischemia in the development of benign prostatic hyperplasia. METHODS: Male rabbits underwent surgical prostatic ischemia for durations of 1, 2, 4, 8 and 12 weeks and sham-operated rabbits served as controls. The weight of prostate was examined and a histological examination conducted. Ki67 immunohistochemical stain for the generation of prostatic cells and TUNEL test for the apoptosis of prostatic cells were used. RESULTS: In sham-operated rabbits, the mean (SD) weight of prostate were 0.831(0.127) g, the mean (SD) positive Ki67 staining prostatic epithelial cells 2.1(0.8) in 100 prostatic epithelial cells and stromal cells 2.6(1.1) in 100, mean (SD) positive TUNEL test prostatic epithelial cells 2.0(1.0) in 100 and stromal cells 2.5(0.7) in 100. In operated rabbits, the generation of prostatic stromal cells increased and the apoptosis of prostatic stromal cells decreased over 1 - 12 weeks. The generation of prostatic epithelial cells increased and the apoptosis of prostatic epithelial cells decreased over 2 - 12 weeks, but in the first week, there were no significantly difference between operated and sham-operated rabbits in the generation and apoptosis of prostatic epithelial cells. The weight of prostate in operated animals increased at Weeks 4, 8 and 12, were significantly heavier than sham-operated rabbits, 1 week post-op and 2 weeks post-op rabbits, there were no significantly difference between the latter 3 groups. CONCLUSION: Ischemia can induce the gain of prostatic weight by improving the generation and inhibiting the apoptosis of prostatic cells. And the effect of ischemia to prostate is correlated with ischemic time. Ischemia may play an important role in the development of benign prostatic hyperplasia. The first response to ischemia is the change of prostatic stromal cells.

[Transrectal high-intensity focused ultrasound with the Sonablate 500 for the treatment of prostate cancer].

OBJECTIVE: To evaluate the clinical effect of transrectal high-intensity focused ultrasound (HIFU) in the treatment of prostate cancer (PCa). METHODS: A total of 57 PCa patients, 27 localized and 30 advanced, underwent transrectal HIFU with the Sonab- late 500, the localized group treated by transrectal HIFU only, while the advanced group by transrectal HIFU combined with androgen ablation. RESULTS: For the HIFU treatment, the mean operating time, hospital stay and follow-up were 111 mm (ranging from 86 to 153 mm), 3.2 days (ranging from 2 to 18 days) and 18 months (ranging from 6 to 30 months), respectively. The biochemical disease-free rates at 1, 2 and 3 years in the localized group were 86%, 81% and 79%, respectively. While in the advanced group, the serum prostate specific antigen (PSA) was < 4.0 microg/L in 26 cases ( < 0.51 microg/L in 20) and the prostate volume decreased more than 50% in 21 cases after treated for an average of 8 months (ranging from 3 to 24 months). After transrectal HIFU prostate ablation, the prostate volume reduced, serum PSA lowered, Qmax raised and IPSS improved significantly (P < 0.05). No serious complications occurred including severe urethrorectal fistula and incontinence. CONCLUSION: Transrectal HIFU is a safe, effective and minimally invasive therapy for patients with prostate cancer.

[Effects of antibiotic and anti-inflammatory treatment on serum PSA and free PSA levels in patients with chronic prostatitis IIIA].

OBJECTIVE: To investigate the effect of antibiotics and a nonsteroidal anti-inflammatory agent on the level of total prostate specific antigen (PSA) and free PSA ratio (F-PSAR) in patients with chronic prostatitis IIIA. METHODS: A total of 228 outpatients diagnosed as with chronic prostatitis III A received 4-week antibiotic and anti-inflammatory treatment. The PSA level and F-PSAR were determined before and after the treatment, and the changes analyzed. RESULTS: Significant variations were observed in the median PSA concentrations (3.51 microg/L and 2.75 microg/L) and F-PSAR (0.25% and 0.27%) 4 weeks after the treatment. Sixty-five of the patients (28.5%) presented with serum PSA greater than 4 ng/ml, the mean PSA decreased by 32.9%, from 6.24 microg/L before the treatment to 4.58 microg/L 4 weeks after the treatment (P < 0.05), and the serum PSA was normalized in 18 of the 65 patients (27.7%). The median variation of F-PSAR (0.16% and 0.22%) was greater than that of PSA. The variation indexes obtained 4 weeks after the treatment showed no statistical difference from those observed 8 weeks after the treatment. CONCLUSION: Chronic prostatitis IIIA appears to contribute to increased serum PSA levels in some men. Antibiotic and anti-inflammatory treatment could significantly reduce the PSA level and increase F-PSAR.

[Seminal parameter analysis in noninflammatory chronic prostatitis/chronic pelvic pain syndrome].

OBJECTIVE: To investigate seminal parameters in noninflammatory chronic prostatitis/chronic pelvic pain syndrome (CAP III B). METHODS: A total of 74 consecutive cases of patients who had been diagnosed as CAP III B and 46 cases of controls were included in the study. Severity of symptoms in men with CAP III B was defined according to the NIH Chronic Prostatitis Symptom Index (NIH-CPSI). All of them underwent a 'four glass-test' including leukocyte determination in expressed prostatic secretions (EPS), voided urine after prostatic massage (VB3) and ejaculate semen followed by analysis according to WHO. The analysis included seminal volume, pH, duration of liquefaction, sperm density, vitality, motility(a + b) and morphology. Correlations between the duration or the severity of symptoms and spermiogram results in patients with CAP III B were assessed respectively. RESULTS: The CAP III B group and the control group differed significantly in ejaculate volume, duration of liquefaction and motility, while the remaining parameters did not differ significantly. The duration of chronic pelvic pain showed apparently positive correlationship with liquefaction time, while the symptom duration negatively correlated with sperm motility. The NIH-CPSI score had no significant relationship with seminal volume, duration of liquefaction and sperm motility. CONCLUSION: Our results indicate that CAP III B can have a significant negative impact on sperm volume, liquefaction and motility. Our data also supports the results that the longer the duration of symptoms, the more influences on semen liquefaction and motility might be.

[Management of urinary obstruction following renal transplantation: report of 16 cases].

OBJECTIVE: To explore the diagnosis and treatment of urinary obstruction involving the transplanted kidney. METHODS: A retrospective analysis was performed in 16 cases of urinary obstruction involving the transplanted kidney, including 5 cases of ureteral calculi, 6 vesicoureteral anastomotic stricture, 2 pyeloureteral junction stricture after transplantation, 1 ureter necrosis due to graft rejection, and 2 infection surrounding the renal graft and ureter end necrosis. RESULTS: Only one patient had the renal graft removed due to massive hemorrhage in an open surgery for correction of urinary obstruction, and the renal function of the graft was preserved in all the other cases after endoscopic or open surgeries. In the follow-up for 0.5 to 3 years after the second surgery, serum creatinine of the patients were maintained within the range of 90-150 micromol/L, without further renal enlargement or exacerbation of renal retention shown by B-mode ultrasonography. CONCLUSION: Urinary obstruction after renal transplantation is a difficult surgical complication, which can be managed by endoscopic or open surgeries depending on the causes of the obstruction.