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Objective To investigate the correlation between prostatitis and bladder outlet obstruction (BOO) in patients with benign prostatic hyperplasia.Methods From January 2008 to January 2012,Three hundred BPH patients were divided into two group according to whether had prostatitis determined by pathology.One hundred and thirty six patients with simple BPH and 164 patients with BPH combined with prostatitis were included with the median age of 69 years.PSA was (4.9 ± 8.3) μg/L and (7.0 ± 8.5)μg/L,the prostate volume was (41.4±18.1) ml and (48.7±20.7) ml,and IPSS was 21.9±7.0 and 27.5 ± 5.1 in BPH group and prostatitis group,respectively.The urodynamic parameters of bladder outlet obstruction between the two groups were analyzed.Results Qmax was (8.8 ± 4.8) ml/s and (6.3 ± 3.7)ml/s,Pdet.Qmax was (96.7 ± 33.0) cm H2O and (113.3 ± 39.8) cm H2O,AG value was 77.7 ± 31.9 and 93.9 ± 39.6,and Schafer grading value was 3.3 ± 1.5 and 4.4 ± 1.2 in BPH group and BPH combined with prostatitis group,respectively (P ＜ 0.05).Logistic regression analysis showed that prostatitis (OR =2.66,P =0.002),PV (OR =1.37,P =0.000),and Qmax(OR =0.72,P =0.000) were positively correlated with Schafer grading value.Conclusions Prostatitis increased the degree of BOO in patients with BPH.
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Objective To investigate the clinical feature,pathologic characteristics and prognosis of non-muscle invasive urothelial bladder tumor in young and old patients.Methods From January 2000 to March 2011,the clinicial data of 48 young patients (age ≤ 40 years) with non-muscle invasive urothelial bladder tumor and 50 patients randomly selected with non-muscle invasive urothelial tumor (age ≥ 60 years) were analyzed and compared retrospectively.There were 38 male and 10 female with a median age of 35.4 years (range,18 to 40).There were 34 male and 16 female with a median age of 68.5 years (range,68.5 to 87).All patients had postoperative intravesical instillation for one year.Young patients presented with gross hematuria mostly,which were similmar with old patients.Solitary tumor were 45 cases and 40 cases,and the multiple tumors were 3 cases and 10 cases in the young and old groups,respectively.Of the young group,40 patients were treated by transurethral resection of bladder tumor,and 8 patients by partial cystectomy.Of the old group,35 patients were treated by transurethral resection of bladder tumor,and 15 patients by partial cystectomy.Results According to 2004 WHO classification of papillary urothelial tumor,lower grade tumor were more frequentto occur in young group than in old group.There was significant difference in incidence of PUNLMP between young group and old group (16/48,33.3％ and 8/50,16.0％,P ＜ 0.05).There was significant difference in incidence of high grade bladder cancer between young group and old group (7/48,14.6％ and 17/50,34.0％,P ＜0.05).The incidence of PTa tumor was 70.8％ and 44.0％ in the young and old groups,respectively (P ＜ 0.05).Median follow up was 34 months (range,6 to 132) in young group and 35 months (range,6 to 130) in old group,respectively.Five-year recurrence rate was 36.7％ and 64.3％ respectively (P ＜ 0.05).Conclusions Non-muscle invasive urothelial bladder tumor in young patients had a better prognosis than those in the old group,with lower grade and stage at diagnosisand lower recurrence rate.
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ObjectiveTo investigate the relationship of lymphotoxin β receptor (LTβR) and classical nuclear factor-κB (NF-κB) activation pathway in the pathogenesis and progress of cystitis and bladder cancer.MethodsThe LTβR and P65 mRNA expression were detected by Real-time quantitative PCR in 108 cases of fresh bladder tissue specimens (75 cases of bladder cancer,10 cases of inflammation and 23 normal bladder mucosa cases grouped by the tissue classification ),and protein expression were analyzed by immunohistochemistry assay in 118 cases of paraffin-embedded biopsy specimens (73 cases of bladder cancer,30 cases of cysitis and 15 normal bladder mucosa cases).The correlation analysis between the expressions of LTβR and P65 with clinical pathological data was then performed.Differences between LTβR and P65 mRNA and protein expression level were compared in different groups of bladder tissues using Kruskal-Wallis H test and the Chi-square test.Results( 1 )The mRNA expressions of LTβR and NF-κB/P65were higher in bladder cancer than those in normal group ( LTβR:29.4 ( 14.2 - 46.7 ) × 10 - 3/1.2 ( 0.3 -7.0) ×10-3,Z=-5.508; P65:9.7 (2.7 -21.1) ×10-3/1.0(0.8 ～1.8) ×10-3,Z=-5.030,P＜0.05 ).There were significantly differences between bladder cancer with different histological grades ( LTβR:18.2(2.1-31.3) × 10-3/ 28.4(16.6-36.2) × 10-3/47.9(34.3 -70.5) ×10-3,x2K-W=20.378;P65:4.9(1.3 - 12.0) × 10-3/7.4(3.0-21.9) × 10-3/17.0(10.0 ～28.3)× 10-3 ,x2K-W2 =15.219,P all ＜0.05) and lymph node metastasis (LTβR:27.2(9.7-40.1) ×10-3/39.4(26.7 -52.6) ×10-3,Z=-2.552; P65:7.4(2.3-15.6) ×10-3/13.4(6.7-23.3) ×10-3,Z=-2.026,P＜0.05).(2)The positive rates of LTβR and phosphorylated P65 ( p-P65 ) protein in cancer were higber than those of normal group (LTβR:69.8％/13.3％,x2 =16.600 ; p-P65:56.2％/6.7％,x2 =12.220,P ＜ 0.05 ).Upregulation of LTβR and p-P65 were associated with the histological grade (LTβR:56.3％/70.0％/90.4％,x2 =7.055; p-P65:40.6％ /60.0％/76.2％,x2 =6.679,P ＜0.05) and with lymph node metastasis (LTβR:58.3％/92.0％,x2 =8.849; p-P65:52.1％/64.0％,x2 =5.088,P ＜0.05).(3)There was a positive correlation between LTβR and P65 expression ( mRNA:r =0.654,P ＜ 0.05,protein:r =0.399,P ＜ 0.05 )in the bladder cancer and cystitis (r =0.521,P＜0.05).ConclusionsThe activation of LTβR and P65 was associated with progression and metastasis of bladder cancer.The activation of classical NF-κB pathway by LTβR may be achieved by P65.
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Objective To evaluate the efficacy and safety of the TVT-Secur procedure for female stress urinary incontinence (SUI). Methods Analyze retrospectively the preoperative, intraoperative and postoperative complications and follow-up data of 27 SUI patients from October 2008 to May 2010. 20 cases were simple SUI, and 7 cases were mixed SUI. The average age was 56.1 ± 10.7 years (range, 35-77), the average parity was 2.8-±- 1.4 (range, 1-6), the average body mass index was 25.6±2.5, and the average course of the disease was 6.8±7.2 yeas (range, 1-30). Two cases had past history of pelvic surgery without any anti-incontinence surgery. Mashall-marchett test was positive in all patients, with an average abdominal leak point pressure (ALPP) of 60.9±27.5 cm H2O (range, 27- 120 cm H2O). The mean International Consultation on Incontinence-Short Form (ICIQ-SF) score was 11.2 ± 1.8 (range, 7- 14) before surgery. Results 27 patients underwent TVT-Secur procedure, of which 19 cases underwent "U" procedure, and 8 cases underwent "H" procedure. The mean operation time was 15.3±1.4min (range, 13- 19 min). There were no intraoperative bladder or urethral injury, and no obturator vessel or nerve damage. The blood loss was 10 to 50 ml, and the maximum urinary flow rate was 25. 4±13. 1 ml (range, 4-50 ml). Three eases had mild dysuria(11. 1%), and 3 cases had wound effusion(11. 1%). Followed up for 12. 6 ±6. 7 months (range, 3-21 months). 10 cases complained of bladder overactivity symptoms such as frequency, urgency, and urge incontinence, and no case had vaginal erosion. Therapeutic efficacy: 15 cases were cured (56%), 8 cases were improved (30%), and 4 cases were ineffective (15%). Conclusions TVT-Secur procedure is a simple, safe and minimally invasive surgery, while the cure rate is low. The long-term efficacy needs great amount of clinical data and long-term follow-up to prove.
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Objective To investigate the etiology and treatment of iatrogenic ureteral injury(IUI) and bladder injury(IBI). Methods Forty-seven patients(7 males, 40 females) with ureteral and bladder inju-ries caused as a result of any medical procedures were reviewed from 1996 to 2007. Obstetrics and gynecolog-ical, urological,general surgical procedures were involved in 38, 6, and 4 of the injuries respectively. Re-sults Sixteen cases of IUI were found during operation, including 14 cases of entire ureteral laceration, 4 cases of partial ureteral laceration. Thirteen cases received ureteral anastomosis, one case received uretero-neopyelostomy. One case of ureteral perforations during ureteroscopic procedure was indweUed of double-J after the operation was terminated immediately. Three cases received nephrectomy. Four cases of lower ure-teric suture ligation and three cases of ureterovaginal fistula were detected at 3 days～ one week of postopera-tion. These 7 cases were received ureteroneocystomy during 2 weeks after the initial surgical procedure. Nineteen cases of IBI were found during operation, the length of cystic wound was ranging from 1 cm to 3 cm. 17 cases underwent repairing, 2 eases of bladder perforation which caused by endourologic or TVT procedure received catheterization for 1 week. Five cases of vesicovaginal fistula which were found during one week--one month of post-operation, were received fistula resection and bladder repairing 3 months after of initial operation. Forty-seven cases were follow-up ranging from 5 months to 11 years after the second opera-tion,mean time were 47 months. All cases were recovered. Conclusions Intraoperative findings and effec-tive treatments can achieve good therapeutic effects and avoid injury during secondary operation. Correct treatment of urinary fistula can promote cure rate.
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Objective To evaluate effectiveness and safety of the transobturator tension-free vaginal tape technique (TVT-O) for the treatment of female stress urinary incontinence(SUI). Methods Twenty-six cases of SUI patients with average (52.6±6.3) years old were included. Mean course of disease was (9.2± 2.3) years. Two cases were type Ⅱ ,23 cases were type Ⅱ/Ⅲ,and 1 case was type ID. One case had history of pelvic operation procedure,2 cases accompanied by urgent urinary incontinence. All cases were undergone TVT-0 procedure. The methods of this procedure and the outcomes and complications were closely analyzed. Results The average operating duration was (18.0 ±2.3) min (15-20 min) and average blood loss was (20.0±3.4)ml (10-40 ml). Twenty-four cases (92.3%) were cured, 2 cases (7.7%) were improved, 2 cases (7.7% ) had dysuria, 1 case improved after prolonged indwelling of catheter, 1 case was recovery with urethral dilations. Four cases (15.4% ) suffered pain of thigh skin around the wound, and relieved by analgesia. One case (3.8%) complained of frequency of micturition, and improved by medicine. Twenty-six cases were followed up of 8-16 months with no recurrence. Conclusion TVT-0 for the treatment of SUI is a simple optimal and reliable method with less complications and eusemia.
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Objective To assess the clinical value of intravesical prostatic protrusion (IPP) measured by transabdominal uhrasonography in judgement of benign prostatic obstruction (BPO). Methods According to pressure-flow study, 109 patients with benign prostatic hyperplasia were di-vided into 3 groups (non-obstruction, equivocal obstruction and obstruction). IPP was measured by transabdominal ultrasonography in all patients. The difference of IPP between different groups was studied and the correlation between IPP and the parameters reflecting BPO was analyzed. Results IPP value of the non-obstruction group, equivocal obstruction group and obstruction group was 2.7 ±1.2 mm, 2.9±1.4 mm and 15.4±6.5 mm. There was significant difference in IPP between the non-obstruction group, equivocal obstruction group and obstruction group (P<0.01). IPP was correlated with the parameters including Pdet. Qbeg, Pdet. Qmax, Pdet. Qend, Qmax and A-G number, Spearman's ratio was 0. 628, 0. 714, 0. 591, -0. 450 and 0. 729(P<0.01), respectively. The sensi-tivity and specificity of judging BPO were 89.9% and 97.5% if the cut-off was IPP≥10 mm. Con-clasion IPP measured by transabdominal ultrasonography could be a convenient and accurate method in diagnosis of BPO.
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Objective To investigate the effect of rice water on prevention of diarrhea in patients with traumatic head injury undergoing enternal nutrition. Methods 110 patients with traumatic head injury in neurosurgery department were selected and randomly divided into the observation group and the control group.The observation group was fed with rice water in the early two days of entemal nutrition and then begun with nutrient solution on the third day, as to the control group,patients were fed with nutrient solution at the beginning of enternal nutrition. Incidence of diarrhea in these two groups were viewed and underwent χ2 test. Results The number of samples with diarrhea in the observation group(3 cases) was significantly less than that of the control group (12 cases). Conclusions Feeding with rice water can clean the intestine, regulate the function of gastrointestinal tract and reduce the incidence of diarrhea obviously in patients with traumatic head injury during the early period of enternal nutrition.
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Objective To study the clinical efficacy and operative skill of multi-endoscopic technique in treatment of post-traumatic urethrostenosis in male patients.Methods A retrospective analysis was done on clinical data of 47 male patients with post-traumatic urethrostenosis treated with direct visional incision urethrotomy combined with transurethral resection of scar tissue and ureteroscopic incision.There were 29 patients with anterior urethral strictures and 18 with posterior urethral strictures.Results Of all,43 patients underwent successful endoscopic surgeries at the first time but one underwent secondary surgery because of unsuccessful endoscopic incision.These patients achieved satisfactory results without urinary incontinence,fistula or reoperation.The left three patients underwent open surgeries because of unsuccessful endoscopic incision,in which one patient could micturate at maximal flow rate of 9-12 ml/s,without therapeutic urethral dilation,one could micturate under regular therapeutic dilation and the other one could not micturate.Conclusions With the advantages of safety,high success rate and good long-term efficiency,multi-endoscopic technique can be used as an initial treatment for male patients with post-traumatic urethrostenosis and is worthy to be popularized.
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Objective To investigate the differentiation of CD4+T helper cell in expressed prostatic secretions(EPS)in type Ⅲ prostatitis. Methods Seventy-six patients were studied,aged from 18 to 47(average 31.8).All patients presented with typical clinical symptoms for over 3 months.Cases were classified as type Ⅲ A(47 cases),type Ⅲ B(29 cases)and control group(16 cases)according to NIH classification system.Type Ⅲ A was also divided into group Ⅲ A1 with 26 cases(mild inflammation)and group Ⅲ A2 with 21 cases(severe inflammation).Th1 cytokine IFN-γ,Th2 cytokines IL-4 in EPS were detected by double antibody sandwich ELISA,and IFN-γ/IL-4 was determined.Results Compared with group control,IFN-γ in group Ⅲ A and Ⅲ B were significantly up regulated (134.78±43.67 pg/ml,109.82±30.09 pg/ml,P＜0.05),while IFN-γ level in group Ⅲ A was higher than in group Ⅲ B(P＜0.05).IL-4 in groupⅢ A was not changed(51.99±20.59 pg/ml,P＞0.05).IL-4 in group ⅢB was higher(76.40±17.99 pg/ml,P＜0.05).IFN-γ/IL-4 in group ⅢA was elevated significantly(2.94±1.12,P＜0.05),while IFN-γ/IL-4 in group ⅢB was not changed(1.49±0.48,P＞0.05).IFN-γ/IL-4 in group Ⅲ A2 was higher than in groupⅢA1 significantly(3.67±0.82vs 2.34±0.97,P＜0.05). Conclusions Th1 eell differentiation took the dominance in type Ⅲ A prostatitis.Th1/Th2 equilibrium was shifted to Th1.It is probably one of the pathogenies that Th1 dominant differentiation leads to local inflammation in prostate of type Ⅲ A prostatitis.
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Objective To study the clinical features,etiology,misdiagnosis of inflammatory pseudotumor in anterovesical space. Methods Four cases of inflammatory pseudotumor in anterovesical space were retrospectively reviewed.Their clinical processes and features were analyzed based on literature. Results In all 4 cases,partial bladder wall was infiltrated.Two cases were misdiagnosed as bladder carcinoma.All tumors and partial walls of bladder were successfully resected.All 4 patients were followed up for 3 months to 6 years.No recurrence was observed. Conclusions Prior ligation of fallopian tube and infection are important etiological factors of inflammatory pseudotumor in anterovesical space.Misdiagnosis can be avoided by analysing the history,clinical condition and special examination.The operative therapy is effective.
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Objective To investigate the clinical features,diagnosis and treatment of spontaneous rupture of renal angiomyolipoma (RAML). Methods A total of 23 cases of spontaneous rupture of renal angiomyolipoma were studied retrospectively.The main clinical manifestations were summarized as follows.Sudden and unexpected lumbar and abdominal pain occurred in 21 cases and lumbar swollen pain in 2.Of them 3 cases concomitantly had hematuria.Nausea and vomiting occurred in 2 cases,shock in 3 and fever in 1.All cases underwent B-ultrasonic examination and 21 had CT examination. Results Diagnosis of RAML was established preoperatively in 16 cases,but 4 cases were misdiagnosed for carcinoma of kidney,1 case for renal infectious disease.Two cases were diagnosed by frozen-section sample during operation.Nephrectomy was performed in 10 cases and nephron sparing nephrectomy in 12,and digital subtraction angiography (DSA) embolization in 1. Conclusions Spontaneously ruptured RAML often changes its clinical symptoms and imaging features,which may result in a high misdiagnosis rate and subsequent nephrectomy.Comprehensive analysis of clinical manifestations and image findings can improve preopreative diagnosis rate,and frozen slice sample examination during operation can avoid unnecessary nephrectomy.
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Objective To evaluate intrasinusal pyelolithotomy for giant staghorn calculi. Methods The data of 22 cases treated with intrasinusal pyelolithotomy were analysed. Results Lithotomy was successful in all cases with the average operation time 116 minutes.Blood transfusion during the procedure was required in 8 cases with an everage of 550 ml.Postoperative examination of 12 cases with B ultrasound revealed residual calculus in 3,the diameters being less than 0.8 cm. Conclusions The procedure for giant staghorn calculi was easy,safe,and effective with renal parenchyma intact.
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Objective To inquire into the diagnosis and management of renal angiomyolipoma.Methods The 22 cases of RAML were studied restrospectively.Results The diagnosis accuracy was 54.5% for B ultrasound and 81.8% for CT,18 were diagnosed as RAML and 4 were misdiagnosed as renal cell carcinoma preoperatively,of which 3 were diagnosed as RAML based on intraoperative frozen section study.11 had been performed enuoleation,7 partial nephrectomy,3 nephrectomy and 1 radical nephrectomy. Conclusions CT is the first line imaging method for RAML.the cow fatty component,intratumor hemorrhage and small tumor are the main canse of misdiagnosis in RAML.careful analysis to clinical feature and imaging data,intraoperative frozen sect,ion study can avoid misdiagnosis.nephron sparing surgery is the best operative management.
