Research progress on surgical factors related to early urinary control after laparoscopic radical prostatectomy.

Radical resection of prostate cancer is the first choice for the treatment of early localized prostate cancer, but urinary incontinence is prone to occur after the operation, especially early urinary incontinence, which seriously affects the quality of life of patients. This article discusses the surgical methods, approaches, and techniques to clarify the effects of surgical-related factors on early postoperative urinary control, in order to provide the best treatment for patients with prostate cancer.

The progress of dorsal vascular complex control strategy in radical prostatectomy.

Radical prostatectomy has undergone a development from open to laparoscopic surgery to a surgical robotic approach. With improved surgical equipment and the continuous development of surgical techniques, various surgical strategies for controlling the dorsal vascular complex (DVC) during RP have been investigated, which affect intraoperative blood loss, postoperative tumour control and postoperative urinary and sexual function. The present narrative review summarizes the latest anatomical information about the prostatic apex and DVC and then describes the three types of DVC control. More detailed anatomy of the DVC is required and the optimal DVC control under different situations needs further research.

Efficacy of modified prostate tip separation technique combined with laparoscopic radical prostatectomy based on propensity score matching / 现代泌尿外科杂志

【Objective】 To explore the efficacy of modified prostate tip separation technique combined with laparoscopic radical prostatectomy based on propensity score matching (PSM) in the treatment of prostate cancer. 【Methods】 A total of 74 prostate cancer patients treated during Jan.2019 and Dec.2022 with modified prostate tip separation technique combined with laparoscopic radical prostatectomy were included in the combined group, and another 63 prostate cancer patients treated during the same period with laparoscopic radical prostatectomy were selected as the control group. Altogether 58 pairs of patients were matched with PSM. The perioperative indicators, incidence of complications, urinary control function and sexual function before and one month after surgery between the two groups after matching were compared. 【Results】 There were no statistically significant differences in general data between the two groups (P>0.05). One month after operation, the scores of the International Urinary Incontinence Questionnaire (ICIQ-SF) and International Erectile Function Questionnaire (IIEF-5) in both groups decreased, while the Expanded Prostate Cancer Index Composite (EPIC-UIN) and International Prostate Symptom Score (IPSS) in both groups increased (P<0.05). The scores of ICIQ-SF [(9.02±1.98) vs. (11.38±2.04)] and IPSS [(19.67±4.19) vs. (21.68±4.23)] were lower in the combined group than in the control group (P<0.05), while the scores of EPIC-UIN [(70.49±6.82) vs. (63.34±6.48)] and IIEF-5 [(18.17±1.73) vs. (16.72±1.58)] were higher in the combined group than in the control group (P<0.05). Compared with the control group, the combined group had shorter catheter retention time [(7.38±1.97) d vs. (5.11±1.82) d] and hospital stay [(13.18±2.23) d vs. (11.74±2.09) d], lower incidence of complications (22.41% vs. 6.90%), and higher positive rate of incision margin (8.62% vs. 20.69%) (P<0.05). 【Conclusion】 PSM can balance the differences between groups. The modified prostate tip separation technique combined with laparoscopic radical prostatectomy can improve the urinary control function, have little impact on sexual function, and cause fewer postoperative complications. However, the risk of positive incision margin is high, and further modification is needed to achieve the best therapeutic effects.

Comparison of the efficacy of transurethral columnar balloon dilation of prostate and transurethral bipolar plasmakinetic resection of prostate in the treatment of small volume (≤30 mL) benign prostatic hyperplasia / 现代泌尿外科杂志

【Objective】 To explore the efficacy of transurethral columnar balloon dilation of prostate (TUCBDP) and transurethral bipolar plasmakinetic resection of prostate (TUPKP) for patients with small volume (≤30 mL) benign prostatic hyperplasia (BPH) and the effects on urinary control and sexual function. 【Methods】 Clinical data of BPH patients who underwent surgical treatment during Jun.2021 and Jan.2022 were reviewed. A total of 95 patients with prostate volume ≤30 mL and regular sexual life were selected as subjects, including 45 patients who received TUCBDP as the TUCBDP group and 50 patients who received TUPKP as the TUPKP group. The patients were followed up for 12 months, and the perioperative data and follow-up results were analyzed. 【Results】 The TUCBDP group had shorter operation time, less intraoperative blood loss, less postoperative hemoglobin loss and sodium concentration loss, shorter bladder irrigation time, lower pain score, shorter urinary tube indwelling time and shorter hospital stay than the TUPKP group (P0.05). The TUPKP group had worse ejaculation function score and ejaculation disturbance score after surgery (P0.05), and the two indexes were superior in the TUCBDP group than in the TUPKP group. The TUCBDP group had significantly lower complication rate than the TUPKP group (P<0.05). 【Conclusion】 TUCBDP is safe and effective in the treatment of small volume (≤30 mL) BPH, less trauma, less biochemical interference, less pain, fewer complications, and shorter course of disease. It has little effect on the ejaculation function and erectile function, and is more suitable for patients requiring retention of sexual function. It has a good application prospect in the treatment of small volume BPH.

Specific nursing improves postoperative urine control function and the self-efficacy of patients undergoing radical prostatectomies.

BACKGROUND: Radical prostatectomy is a treatment for prostate cancer (PC), but most patients suffer urinary incontinence, decreased urinary control function, and poor prognoses after the surgery. Specific nursing intervention is a nursing model based on the patients' individual conditions and disease progression. OBJECTIVE: To investigate the effects of specific nursing intervention on the urinary control functions and self-efficacy of radical prostatectomy patients. METHODS: From April 1, 2016 to June 30, 2019, 149 patients who underwent radical prostatectomies in our hospital were retrospectively selected for this observational study and assigned to two groups in accordance with the different nursing intervention method each patient underwent. Seventy-six patients who underwent specific nursing intervention were included in the observation group (OG), and 73 patients who underwent routine nursing intervention were included in the control group (CG). The clinical symptoms, the urodynamic indexes, the recoveries of urinary control function, the incidences of urinary incontinence, and the complications were observed in both groups. The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores were used to evaluate the unhealthy emotions. The self-efficacy scale (GSES) and SF-36 were used to evaluate the self-efficacy and the quality of life (QOL), respectively. RESULTS: After the nursing, the improvement in the clinical symptoms in the OG was significantly better than it was in CG. The improvement in the postoperative urodynamic indexes in the OG was significantly better than it was in the CG. The recovery of urinary control function in the OG was significantly higher than it was in the CG. The incidence of urinary incontinence in OG was significantly lower than it was in the CG. The incidence of complications in the OG was significantly lower than it was in the CG. The SAS and SDS scores in the OG were significantly lower than they were in the CG. After the intervention, the patients' GSES and SF-36 scores in the OG were significantly higher than they were in the CG. CONCLUSION: Specific nursing intervention can ameliorate the urinary control functions and self-efficacy, reduce unhealthy emotions, and improve the QOL of radical prostatectomy patients.

Our initial experience with the three layers with three-port approach for laparoscopic radical cystectomy.

INTRODUCTION: Radical cystectomy (RC) remains the gold standard for the treatment of recurrent high-risk non-muscle-infiltrating bladder cancer (BC) and muscle-infiltrating BC. Currently, there is no uniform standardized procedure for laparoscopic radical cystectomy (LRC). AIM: To share our initial experience with the three layers with three-port approach for laparoscopic radical cystectomy (TLTPA-LRC) and to investigate its safety and effectiveness. MATERIAL AND METHODS: Between April 2017 and March 2020, 32 patients with bladder tumors underwent TLTPA-LRC, pelvic lymph node dissection, and extracorporeal construction of the Studer neobladder. The basic characteristics of the patients, clinical pathology, and perioperative and follow-up data were analyzed. We also describe our step-by-step surgical technique for TLTPA-LRC. RESULTS: The median operation time was 278.5 min (range: 221-346 min), and the mean estimated blood loss was 233.4 ml (102-445 ml). The rates of intraoperative blood transfusion and postoperative transportation to the intensive care unit after surgery were 12.5% and 100%, respectively. Postoperative pathology showed 7 cases of T1, 20 cases of T2, and 5 cases of T3. Lymph node dissection and surgical margins were both negative. During a median follow-up of 13.5 months, 4 patients had early complications (< 30 days) and no patients had major complications (grade ≥ 3). The patients are now alive without local metastasis and with satisfactory urinary control ability day and night. CONCLUSIONS: Although the TLTPA-LRC approach requires a certain level of surgical proficiency, it is feasible and serves as a minimally invasive method for selected patients.

Study on the value of improved urinary control technology in patients with benign prostatic hyperplasia / 中国医师进修杂志

Objective:To explore the application effect of improved urinary control technology in patients with benign prostatic hyperplasia (BPH).Methods:A total of 83 BPH patients admitted to Taihe County People′s Hospital of Anhui Province from June 2017 to August 2020 were selected and divided into the control group (41 cases) and the observation group (42 cases) by a random number table. The control group performed transurethral plasma kinetic enucleation of prostate (PKEP), and the observation group performed modified urinary control technology. The general conditions of surgery, voiding function, urinary control function, sexual function and complication rate were compared between the two groups.Results:Compared with the control group, theoperation time in the observation group was longer and the postoperative hospital stay was shorter: (78.67 ± 20.04) min vs. (69.52 ± 18.66) min, (8.64 ± 2.66) d vs. (10.95 ± 3.01) d, there were statistical differences ( P<0.05). The postvoid residual (PVR) and the maximum flow rate (Q max) in the two groups at 1 month and 3 months after operation had no significant differences ( P>0.05). The incidence of urinary incontinence in the observation group at 24 h, 1 week, and 2 weeks after extubation were lower than those in the control group: 11.90%(5/42) vs. 36.59% (15/41), 4.76%(2/42) vs. 21.95%(9/41), 2.38%(1/42) vs. 19.51%(8/41), there were statistically differences ( P<0.05). After operation for 3 months, the total incidence of adverse events in the observation group was lower than that in the control group: 4.76% (2/42) vs. 19.51% (8/41), P<0.05. Conclusions:The improved urinary control technology has a significant application effect in BPH patients. It can effectively improve the patient′s urination function, protect urinary control and sexual function.

Effects of modified radical prostatectomy via an extraperitoneal approach on urinary control and sexual function in patients with prostate cancer / 中国基层医药

Objective:To investigate the effects of modified radical prostatectomy via an extraperitoneal approach on urinary control and sexual function in patients with prostate cancer.Methods:Fifty-six patients with stable prostate cancer who received treatment in Deqing People's Hospital between March 2015 and March 2018 were included in this study. They were randomly divided into observation and control groups ( n = 28/group). The observation group was subjected to modified radical prostatectomy via an extraperitoneal approach. The control group underwent standard laparoscopic surgery. Clinical efficacy and the effects of modified radical prostatectomy via an extraperitoneal approach on urinary control and sexual function were compared between the two groups. Results:Amount of blood loss and postoperative drainage were (125.39 ± 11.12) mL and (65.39 ± 10.12) mL in the observation group, and (224.79 ± 14.01) mL and (104.79 ± 15.01) mL in the control group. There were no significant differences in amount of blood loss and postoperative drainage between the two groups ( t = 18.83, 15.67, both P < 0.05). At 1, 3 and 6 months after surgery, the percentage of patients who had urinary control recovery in the observation group was 53.57% (15/28), 78.57% (22/28), 98.21% (27/28), respectively, which were significantly higher than those in the control group [21.43% (6/28), 35.71% (10/28), 67.86% (19/28), χ2 = 4.12, 7.21, 5.01, all P < 0.05]. At 1, 3 and 6 months after surgery, the score of erectile function recovery in the observation group was (15.98 ± 0.28) points, (15.99 ± 0.72) points, and (18.91 ± 0.48) points, which were significantly higher than those in the control group [(17.11 ± 0.34) points, (13.11 ± 0.48) points, (13.41 ± 0.39) points, t = 3.01, 12.89, 15.78, all P < 0.05]. Conclusion:Modified radical prostatectomy via an extraperitoneal approach can improve postoperative urinary control and sexual dysfunction.

Effect of laparoscopic transvesical radical prostatectomy on sexual function and urinary control / 中华泌尿外科杂志

Urinary incontinence and sexual dysfunction are common complications after prostatectomy. The clinical data of 12 patients with low-risk localized prostate cancer treated in Shanghai Jiao Tong University Affiliated 6th People’s Hospital from November 2017 to November 2018 were analyzed retrospectively. All patients underwent transvesical laparoscopic radical prostatectomy. The recovery of urinary control and erectile function was satisfactory, with few complications and definite tumor control effect.

Monosymptomatic enuresis: the therapeutic weapons.

Nocturnal enuresis (NE) was defined by the World Health Organization (ICD-10) and the American Psychiatric Association (DSM-5) as bed-wetting in children aged >5 years. In cases of mental retardation, the developmental age may be equivalent to 5 years. In this review, we focus on the current knowledge about the etiology of enuresis and the most recent therapeutical options. Both non-pharmacological and pharmacological therapies are included, although the relative effectiveness of each remains uncertain. To date, motivational, alarm and drug therapies are the mainstay of treatment. Alarm therapy remains the first-line treatment modality for NE, while desmopressin is the most commonly used medical treatment.

Delayed versus standard ligature of the dorsal venous complex during laparoscopic radical prostatectomy: A systematic review and meta-analysis of comparative studies.

PURPOSE: To evaluate current views on comparing delayed ligature of the dorsal venous complex (D-DVC) with standard ligature of the dorsal venous complex (S-DVC) for safety, urinary control and oncological outcomes during laparoscopic radical prostatectomy. METHODS: A comprehensive searching of PubMed, Web of science, Embase and the Cochrane Library was made and then we performed a meta-analysis, including all randomized controlled trials (RCTs) and retrospective studies, to evaluate the two different techniques. RESULTS: Two RCTs and six retrospective studies containing 1822 cases (222 cases from RCTs and 1600 cases from retrospective studies) were identified. Although D-DVC was related to more blood loss (WMD: 7.30 mL; 95% CI, 2.43 to 12.16; p = 0.003), the blood transfusion rate between the two groups showed no significant difference (OR = 1.93; 95% CI, 0.55 to 6.73; p = 0.31), and patients in the D-DVC group could benefit from a shorter operative time (WMD: -30.83 min; 95% CI, -53.32 to -8.35; p = 0.007). Positive apical margin events were significantly less in the D-DVC group (OR = 0.39; 95% CI, 0.22 to 0.71; p = 0.002). As for urinary control, there were no differences in continence rates after 3 months (OR = 1.64; 95% CI, 0.98 to 2.73; p = 0.06) and 12 months (OR = 1.00; 95% CI, 0.63 to 1.57; p = 0.99) of follow-up. However, there was a significantly higher continence rate after 6 months of follow-up in the D-DVC group (OR = 1.46; 95% CI, 1.02 to 2.11; p = 0.04). CONCLUSIONS: Standard and delayed approaches to DVC are equally safe and result in similar urinary control. The delayed approach could decrease the positive apical margin rate. However, further large-scale prospective studies are needed to investigate and compare the prognosis and long-term functional outcomes between the two approaches.

Postoperative urinary function recovery after complete robotic assisted radical cystectomy and in situ U-shaped ileal neobladder / 中华泌尿外科杂志

Objective To investigate postoperative urinary function recovery after complete robotic assisted radical cystectomy and in situ U-shaped ileal neobladder.Methods Retrospective analysis of 79 cases of local progression bladder cancer (cT2-3 N0-2 Mo) in our hospital from September 2014 to September 2018.79 cases were confirmed by pathology as high-grade uroepithelium cell carcinoma of bladder.Posterior urethra and bladder neck biopsy did not see tumor invasion.The urodynamic examination for all patients before surgery showed no significant decrease in urinary control function.Preoperative International urinary Incontinence Advisory Committee urinary Incontinence Questionnaire summary confirmed that there was no obvious urinary incontinence symptoms.All patients underwent radical bladder resection and in situ Ushaped ileum new bladder surgery.40 cases in the experimental group were treated with complete robot assisted radical bladder resection and in situ U-shaped ileum new bladder.39 cases in control group were treated with laparoscopic surgery.There was no statistically significant difference between the two groups of general data (both P ＞ 0.05).The operation time,bleeding volume,positive rate of postoperative incision,postoperative hospitalization time,new bladder capacity,residual urine volume,maximum urinary flow rate,bladder internal pressure,unilateral ureteral reflux and stenosis incidence,as well as immediate urinary control rate after extraction of catheter and 1,3,6 and 12 months of urinary control recovery were compared.Results 79 cases of this study were successfully completed.The operation time of the two groups [(286.5 ±37.2) min vs.(288.5 ±32.9) min,P =0.801],intraoperative blood loss[(185.1±41.6) ml vs.(189.3 ±54.2) ml,P =0.700].There was no significant difference in the average postoperative hospital stay [(14.3 ± 1.6)d vs.(14.9 ±2.2)d,P =0.168].The margins of the pathological examinations in both groups were negative.New bladder volume after surgery [(300 ± 10) ml vs.(245 ± 10) ml,P ＜ 0.001].Urodynamic examination of residual urine volume [(20 ± 10) ml vs.(50 ± 10) ml,P ＜0.001],maximum urine flow rate [(16 ±4) m1/s vs.(13 ±2) m1/s,P =0.006].Intravesical pressure [(22.5 ±3.0) cmH2Ovs.(17.5 ± 2.5) cmH2O,P ＜ 0.001] (1 cmH2O =0.098 kPa).The two groups of postoperative cystoscopy showed that unilateral ureteral reflux was 5％ (2/40) and 20.5％ (8/39),respectively,and the unilateral ureteral anastomotic stenosis was 2.5％ (1/40) and 15.4％ (6/39) after operation,and the difference was statistically significant (P =0.038,P =0.044).The urine control rate of the observation group and the control group immediately after removal of the catheter was 37.5％ (15/40) and 15.4％ (6/39),respectively.The urine control rate in 1 month was 62.5％ (25/40) and 38.5％ (15/39),respectively.The urine control rate in 3 month was 82.5％ (33/40)and 56.4％ (22/39),the difference was statistically significant (P =0.026,P =0.033,P =0.012).At other follow up time points,there was no significant difference in point-controlled urine rate (P ＞ 0.05).Conclusions Complete robot-assisted radical cystectomy and in situ U-shaped ileal neobladder surgery are more advantageous than standard laparoscopic surgery in time of the early recovery urinary function.

Effect of passive finger exercises on grip strength and the ability to perform activities of daily living for older people with dementia: a 12-week randomized controlled trial.

BACKGROUND: Dementia adds burden to society. As it is not curable, physical exercise activities are optimal to improve the physical strength and quality-of-life of people with dementia. AIM: Design, implementation, and examination of a set of passive finger exercises and their effects on improving grip strength and activities of daily living (ADL) for older people with dementia. METHODS: Forty older people with dementia were recruited and randomly allocated into an experimental group and a control group, each with 20 people. The control group received routine nursing care. In addition to this, the experimental group received 25-minutes of passive finger exercises every day for 12 weeks. The health outcomes measured were grip strength and ADL, before and after the intervention. Grip strength was assessed by electrical hand muscle dynamometer. ADL were assessed with Barthel index. RESULTS: Although there was no effect on grip strength, passive finger exercises led to significant improvements in urinary control, defecation function, and overall ADL in comparison with the control group. IMPLICATIONS FOR PRACTICE: Passive finger exercises can be integrated into physical exercise programs for older people with dementia to improve their urinary control, defecation function, and ADL.

TGF-ß/MAPK signaling mediates the effects of bone marrow mesenchymal stem cells on urinary control and interstitial cystitis after urinary bladder transplantation.

OBJECTIVE: This study aimed to explore the role of the transforming growth factor-ß/mitogen activated protein kinase (TGF-ß/MAPK) signaling pathway in the effects of bone marrow mesenchymal stem cells (BMSCs) on urinary control and interstitial cystitis in a rat model of urinary bladder transplantation. METHODS: A urinary bladder transplantation model was established using Sprague-Dawley rats. Rats were assigned to normal (blank control), negative control (phosphate-buffered saline injection), BMSCs (BMSC injection), sp600125 (MAPK inhibitor injection), or protamine sulfate (protamine sulfate injection) groups. Immunohistochemistry, urodynamic testing, hematoxylin-eosin staining, Western blotting, enzyme-linked immunosorbent assay, and MTT assay were used to assess BMSC growth, the kinetics of bladder urinary excretion, pathological changes in bladder tissue, bladder tissue ultrastructure, the expression of TGF-ß/MAPK signaling pathway-related proteins, levels of inflammatory cytokines, and the effects of antiproliferative factor on cell proliferation. RESULTS: Compared with normal, negative control, BMSCs, and sp600125 groups, rats in the PS group exhibited decreased discharge volume, maximal micturition volume, contraction interval, and bladder capacity but increased residual urine volume, bladder pressure, bladder peak pressure, expression of TGF-ß/MAPK signaling pathway-related proteins, levels of inflammatory cytokines, and growth inhibition rate. Levels of inflammatory cytokines and the growth inhibition rate were positively correlated with the expression of TGF-ß/MAPK signaling pathway-related proteins. CONCLUSIONS: Our findings demonstrate that the TGF-ß/MAPK signaling pathway mediates the beneficial effects of BMSCs on urinary control and interstitial cystitis.

The risk factors for urinary function recovery after radical prostatectomy / 中华泌尿外科杂志

Objective To investigate the adverse risk factors of urinary function recovery after radical prostatectomy.Methods The clinical data of 126 patients treated with laparoscopic radical prostatectomy from October 2015 to October 2016 were collected and analyzed retrospectively.The mean age was 70 years (48-85 years).The BMI was 16.8-24.7 kg/m2(mean 24.6 kg/m2).The PSA was 1.73-274.5 ng/ml (median 12.06 ng/ml).26 cases had positive surgical margins.There were 62 cases in lower age group (＜70 years) and 64 cases in higher age group(≥70 years).The BMI of the lower age group and the higher age group were (25.35-± 3.66) and (24.00 ± 3.11) kg/m2 (P =0.028).The median PSA of the lower age group and the higher age group were 13.41 and 10.26 ng/ml(P =0.304).The PSA ＜ 10、10-20、＞ 20 ng/ml for two groups were 22,17,20 and 29,18,20 (P =0.41).The Gleason ≤ 6,7,≥ 8scores for two groups were 6,18,38 and 7,24,33 (P =0.168).All patients were followed up for 48 weeks,and the risk factors for patients with poor control of uhnary function were analyzed.Results The overall recovery rate of continence 12 weeks after surgery was 46.8％ (59/126),with lower age group 56.5％ (35/62) and higher age group 37.5％ (24/64) (P ＜0.05).The rate of 24 weeks after surgery was 88.1％ (111/126),with lower age group 93.5％ (58/62)and higher age group 82.8％ (53/64)(P ＜0.05).In a univariate logistic regression test,the age (P =0.034),BMI (P =0.044) and nerve sparing (P =0.005) were associated with recovery of urinary continence within 12 weeks after surgery (P ＜ 0.05).In multivariate logistic regression analysis,age (P =0.011),BMI (P =0.022) and nerve reserved (P =0.014) were independent factors that predicted the recovery of continence within 12 weeks after surgery (P ＜ 0.05).Conclusions Younger age,lower BMI and intraoperative nerve preservation independently predicted recovery of continence within 12 weeks.Age is the influencing factor of continence recovery within 24 weeks.

Treatment for Enuresis

Monosymptomatic enuresis(bed-wetting without other symptoms) is a common problem in children, affecting 15% of five-year-olds and occurring more frequently in boys than in girls. Because it is usually caused by a physiologic maturational delay, the prevalence decreases with age. Children with enuresis have a small bladder capacity. Failure to awake to the micturition urge is not necessarily related to being a "deep sleeper", and children with enuresis may pass urine involuntarily because of the immature central nervous pathways. As the CNS pathways matures with age, most children are more easily aroused from sleep. There is strong evidence of a genetic predisposition for enuresis. Children with enuresis must be evaluated to reveal any underlying physiologic conditions or disease states, such as urinary tract infection or structural abnormality. Once these are ruled out, the goal is to stop the bed-wetting while preserving the child's self-esteem. However, before treatment of enuresis, concurrent problems, such as daytime enuresis and urgency or chronic constipation, should be managed. For the treatment of enuresis, the child wears a moisture alarm-a small, portable, transistorized device-to bed. The alarm sounds or vibrates when wet, awakening the child. Drug therapy for enuresis includes desmopressin, which decreases the urine volume, and imipramine and oxybutynin, which inhibit bladder contraction. Both delayed urinary control and current enuresis are associated with a markedly increased risk of behavioral, emotional, and academic problems.