Effects of botulinum toxin A injections in spinal cord injury patients with detrusor overactivity and detrusor sphincter dyssynergia.

OBJECTIVE: To evaluate the safety and effect of botulinum toxin A injection in the detrusor and external urethral sphincter in male patients with detrusor overactivity (DO) and detrusor external sphincter dyssynergia (DESD) secondary to spinal cord injury. METHODS: A multicentre trial was conducted from June 2012 to August 2015. A total of 65 spinal cord injury patients with DO and DESD participated in the study. Of these, 59 received 200 U botulinum toxin Aintradetrusor and 100 U external urethral sphincter injections. The effective outcomes included maximum detrusor pressure at first DO and DESD, VDO-DESD, maximum urethral closure pressure, duration of first DO and DESD, Incontinence-Specific Quality-of-Life Instrument, voiding volume, urinary incontinence episodes and complete dryness. Adverse events were recorded. RESULTS: All patients experienced a significant mean reduction in PdetmaxDO -DESD (46.60%), maximum urethral closure pressure (29.61%), duration of first DO and DESD (42.93%) and a significant mean increase in VDO-DESD (38.11%) 12-weeks post-injection. Significant (p < 0.001) improvement in mean Incontinence-Specific Quality-of-Life Instrument, voiding volume, urinary incontinence episodes and complete dryness were found in all patients at 2 weeks and were sustained at 8 weeks and 16 weeks. CONCLUSION: Botulinum toxin A injection in the detrusor and external urethral sphincter is an effective treatment to protect the upper urinary tract and improve quality of life for patients with DO and DESD secondary to spinal cord injury.

Cystitis glandularis: A controversial premalignant lesion.

Cystitis glandularis (CG) has been hypothesized as a potential precursor of adenocarcinoma, although this remains controversial. The present study reports data accumulated from 166 cases of cystitis glandularis with follow-up periods ranging between 0.5 and 17 years. The association between intestinal and typical CG and bladder carcinoma was retrospectively evaluated. The patients included in the present study had presented with typical (n=155) or intestinal (n=11) CG between 1994 and 2010. Of those patients, concurrent carcinoma of the bladder was identified in 15 (9.0%) patients, including two cases of squamous cell carcinoma and 1 case of sarcoma. The cases of carcinoma were identified either prior to or concurrently with the diagnosis of CG. Follow-up was available for 9/11 (81.8%) patients with intestinal CG. Nine months following transurethral fulguration, 8/11 (72.7%) patients were in complete remission and 1/11 (9.1%) complained of urgency and dysuria; two patients were lost to follow-up. The follow-up of the patients ranged from 0.7 to 4.5 years (median, 2.67 years; mean, 2.82 years). No evidence of subsequent carcinoma was identified in any of the patients during the follow-up of the intestinal and typical CG groups. In addition, there was no evidence of carcinoma subsequent to CG in either of the typical or intestinal CG groups. The results did not support that CG increases the future risk of malignancy in the short term and repeated cystoscopies over a short period of time are not recommended.

Effectiveness and complication rates of tension-free vaginal tape, transobturator tape, and tension-free vaginal tape-obturator in the treatment of female stress urinary incontinence in a medium- to long-term follow up. Meta-analysis of randomized controlled trials.

OBJECTIVE: To evaluate the effectiveness and complications of tension-free vaginal tape (TVT), transobturator tape (TOT), and tension-free vaginal tape-obturator (TVT-O) in a medium- to long-term follow up. METHODS: We searched PubMed, EMBASE, Cochrane database, ClinicalTrials.gov, Google Scholar, and the International Continence Society (ICS) website from August to December 2012 in Guangzhou First People's Hospital, Guangzhou, China. Randomized controlled trials (RCTs) comparing the effectiveness and complications of TVT, TOT, and TVT-O were selected. RESULTS: Forty RCTs were included. The TVT and TOT had similar subjective (risk ratio [RR]: 0.99; 95% confidence interval [CI]: 0.93-1.04), and objective cure rates (RR: 0.96; 95% CI: 0.70-1.32). However, TVT had a reduced risk of groin/thigh pain (RR: 0.33; 95% CI: 0.18-0.59). The subjective (RR: 1.02; 95% CI: 0.97-1.06) and objective cure rates (RR: 1.02; 95% CI: 0.99-1.06) of TVT-O were similar to TVT, but TVT had a higher risk of bladder perforations (RR: 2.29; 95% CI: 1.18-4.45). The TVT-O and TOT had similar subjective (RR: 0.99; 95% CI: 0.93-1.06), and objective cure rates (RR: 1.01; 95% CI: 0.95-1.07). However, TVT-O had a lower risk of vaginal erosion rates (RR: 0.16; 95% CI: 0.03-0.89). CONCLUSION: The subjective and objective cure rates of stress urinary incontinence were similar among TVT, TOT, and TVT-O in a medium- to long-term follow up. The TVT had a higher risk of bladder perforation than TVT-O, and a lower risk of groin/thigh pain than TOT, and TVT-O had a lower risk of vaginal erosion rates than TOT.

Transurethral enucleation and resection of the prostate vs transvesical prostatectomy for prostate volumes >80 mL: a prospective randomized study.

OBJECTIVES: To compare the efficacy and safety of transurethral enucleation and resection of the prostate (TUERP) and transvesical prostatectomy (TVP) for patients with benign prostatic hyperplasia (BPH) and prostate volumes >80 mL. PATIENTS AND METHODS: A total of 100 patients with urodynamic obstruction and prostate volume >80 mL were prospectively randomized and enrolled in the study at a tertiary hospital. Patients underwent TVP or TUERP performed by one of two surgeons with experience of a large number of cases. All patients were preoperatively evaluated using patient age, prostate volume measurement, clinical characteristics of digital rectal examination, self-assessment using the International Prostate Symptom Scores (IPSS) questionnaire, a quality-of-life (QoL) questionnaire, maximum urinary flow rate (Qmax ), post-void residual urine volume (PVR), urine analysis, blood sample analysis, including determination of prostate-specific antigen (PSA) and haemoglobin concentration. All patients were assessed peri-operatively and postoperatively at 3 and 12 months. All complications were documented. RESULTS: Of 100 patients eligible to participate, 92 patients completed 12 months of follow-up. Patients who underwent TUERP had shorter catheterization times and hospital stays. Operation duration was not significantly different between the two surgical groups (P = 0.107). The resected adenoma weight in the TVP group was more than that in the TUERP group, but the difference was not significant (P = 0.062). There were no significant differences in IPSS, PVR, Qmax or QoL scores between the groups at 3 and 12 months. The patients in the TVP group appeared to have a better Qmax at 3 months, however, the difference was not significant (P = 0.081). Adverse events were similar in the two groups. CONCLUSION: We found that TUERP had efficacy and safety equivalent to that of TVP for patients with BPH and prostate volume >80 mL.

[Holmium laser enucleation versus open prostatectomy for large volume benign prostatic hyperplasia: a meta-analysis of the therapeutic effect and safety].

OBJECTIVE: To compare holmium laser enucleation (HoLEP) versus open prostatectomy (OP) for large volume benign prostatic hyperplasia. METHODS: The randomized controlled trials (RCTs) pertaining to HoLEP and OP for management of large volume benign prostatic hyperplasia were retrieved from Medline and Embase. Meta-analysis was performed using Review Manager 5.0 software. RESULTS: Three RCTs were included in the analysis. No significant differences were found in IPSS or Qmax between HoLEP and OP (P>0.05). Compared with OP, HoLEP was associated with significantly less blood loss, a shorter catheterization time and a shorter hospital stay, but a longer operating time. HoLEP and OP were similar in terms of urethral stricture, stress incontinence, transfusion requirement and the rate of reintervention. CONCLUSION: HoLEP and OP have similar therapeutic effects in the management of large volume benign prostatic hyperplasia. Although with a longer operating time and less resected tissue, HoLEP causes less blood loss and requires a shorter catheterization time and a shorter hospital stay. HoLEP has a comparable safety to OP in terms of the adverse events.

Urodynamically diagnosed detrusor hypocontractility: should transurethral resection of the prostate be contraindicated?

BACKGROUND: Patients with benign prostatic hyperplasia (BPH) suffering from hypocontractile detrusor were generally regarded unsuitable for surgery. This prospective study is to evaluate the efficacy of transurethral resection of the prostate (TURP) on BPH patients diagnosed detrusor hypocontractility on urodynamic study (UDs). METHODS: Twenty patients were included in the study with mean age of 74.20 ± 7.93 years (range: 57-88). Outcomes were determined by patients' self-assessment questionnaires, International Prostate Symptom Score (IPSS) and Quality of Life (QoL), and UDs parameters including maximum uroflow rate (Qmax), postvoid urine volume (PVR), bladder compliance, maximal cystometric capacity (MCC), and maximum detrusor pressure (Pdetmax). RESULTS: Median follow-up duration was 12 months (range: 10-16). After TURP, IPSS/QoL, Qmax, PVR, and Pdetmax were significantly improved and there were no significant differences with regard to bladder compliance and MCC. CONCLUSION: UDs may play a very limited role in detecting bladder outlet obstruction (BOO) in BPH patients with hypocontractile detrusor. TURP may obtain a promising effect on such patients with unidentified BOO. These patients should not be arbitrarily excluded from surgical indications simply based on UDs findings.

Lost to follow-up in high level evidence-based studies related to the surgical management of lower urinary tract symptoms secondary to benign prostatic enlargement: does it matter?

AIMS: A contemporary review of the literature on benign prostatic hyperplasia (BPH) for lost to follow-up (LTF) rate was performed to evaluate the significance of LTF in the surgical management of lower urinary tract symptoms (LUTS) secondary to benign prostatic enlargement (BPE). METHODS: Randomized clinical trials (RCT level I) on the surgical treatment of LUTS secondary to BPE, with at least 12-month follow-up, from 1/1995 to 10/2010 were searched on PUBMED. Data reviewed included types of study, number of participating centers or hospitals, sample size calculation, surgical techniques, power calculation, estimated dropout rate, duration of follow-up, rate and reasons for LTF. RESULTS: Forty-eight RCT articles were identified. Eleven articles gave details on sample size calculation, and 13 explained their LTF rate after reaching LTF patients by mail or telephone. Percentages of LTF patients were 12% (492/4202) at 12 months in 39 articles, 21% (398/1891) at 24 months in 16 articles, 33% (485/1479) at 36 months in 11 articles, 41% (283/694) at 48 months in 6 articles, and 56% (409/729) at ≥60 months in 6 articles. Fifteen articles reported no missing data, mostly because of small sample size or short follow-up. Only 7 articles defined LTF patients as treatment failure and reported outcomes accordingly. CONCLUSIONS: The increase in LTF rate over time compromises the strength of the conclusions from the leftover patient population. Only 15% of RCTs adhered to the CONSORT statement by considering their LTF patients as treatment failures.

Prolapse follow-up at 5 years or more: myth or reality?

OBJECTIVES: To study the loss to follow-up (LTF) rate in level I/II evidence-based studies related to the surgical management of pelvic organ prolapse (POP). METHODS: Randomized controlled trials (level I) or nonrandomized but prospective studies (level II) related to the surgical treatment of POP from January 1995 to November 2010 were searched in PubMed. Data reviewed included types of study, number of participating centers, sample size calculation, surgical techniques, power calculation, estimated dropout rate, duration of follow-up, and rate and reasons for LTF. RESULTS: Forty-eight articles (4776 women)--22 randomized controlled trials and 26 nonrandomized prospective studies--met the inclusion criteria. Twenty-one articles gave details on sample size calculation, and only 5 explained their LTF rate after reaching LTF patients by mail or telephone. Percentages of LTF patients were 9.8% (255/2609) at ≤12 months in 26 articles, 15% (184/1232) at 24 months in 12 articles, 27% (114/420) at 36 months in 8 articles, 44% (272/615) at 60 months in 4 articles, and 60% (273/456) at >60 months in 3 articles. Fifteen articles reported no missing data, mostly because of small sample size or short follow-up. Only 3 articles defined LTF patients as treatment failure or successes and reported outcomes accordingly. CONCLUSIONS: An acceptable attrition rate (10-20%) in studies with a 2-3-year follow-up period was noted, but a much higher rate in studies extending 3-5 years out. Meaningful long-term follow-up reporting at 5 years, as usually recommended after POP repair, seems unrealistic.

Level I/II evidence-based studies of surgical treatment of female stress urinary incontinence: patients lost to followup.

PURPOSE: We determined the rate of patients lost to followup in level I/II evidence-based studies of surgical management of stress urinary incontinence in women. MATERIALS AND METHODS: Randomized clinical trials (level I) or nonrandomized but prospective studies (level II) related to surgical treatment of stress urinary incontinence in women from January 1995 to November 2009 were searched on PubMed®. Data reviewed included study type, number of participating centers or hospitals, sample size calculation, surgical techniques, power calculation, estimated dropout rate, followup duration, and rate of and reasons for loss to followup. RESULTS: A total of 47 randomized clinical trials and 24 nonrandomized prospective studies, representing a total of 11,007 women, met study inclusion criteria. Of the articles 33 provided details on sample size calculation and 16 explained the lost to followup rate after contacting patients lost to followup by mail or telephone. The incidence of patients lost to followup was 8.1% (587 of 7,213) at 12 months or less in 58 articles, 28% (813 of 2,890) at 24 months in 13, 36% (248 of 694) at 36 months in 5, 33% (233 of 708) at 36 to 60 months in 5 and 32.4% (722 of 2,227) at 60 months or greater in 10. A total of 11 articles reported no missing data due to small sample size or short followup. Only 7 articles defined cases lost to followup as treatment failures and reported outcomes accordingly. CONCLUSIONS: In this contemporary literature review we found an important attrition rate of followup with time that directly affects the strength of the conclusions on the remaining patient population.

A randomized trial of transvesical prostatectomy versus transurethral resection of the prostate for prostate greater than 80 mL.

OBJECTIVES: We compared the safety and efficacy of transvesical prostatectomy (TVP) and transurethral resection of the prostate (TURP) for prostate greater than 80 mL in a prospective randomized trial. METHODS: Eighty patients with urodynamic obstruction and prostate volume >80 mL were prospectively randomized and assigned to TVP or TURP. Patients were assessed preoperatively and followed up at 3 and 12 months postoperatively. International prostate symptom score (IPSS), quality of life score (QoLS), maximum flow rate (Q(max)(.)), and postvoid residual volume (PVR) were obtained at each follow-up. Perioperative data and postoperative outcomes were compared. All complications were recorded. RESULTS: Of 80 patients eligible to participate, 69 patients completed 12 months of follow-up. TURP procedure was not faster than TVP procedure (P = .41); 53.2% and 84.4% of prostatic tissue were resected after TURP and TVP, respectively (P < .001). In the TVP group, IPSS, Q(max)(.), QoLS, and PVR volume were significantly better than those in TURP group at 3 and 12 months of follow-up. At 12 months postoperatively, IPSS improved 87.6% and 62.3%, mean Q(max)(.) increased by 11.49 mL/s (230.2%) and 6.33 mL/s (102%), and mean PVR volume decreased by 71.2 mL (88.6%) and 65.4 mL (70.5%) in TVP and TURP group, respectively. Two TURP patients developed urethral stricture requiring reoperation. CONCLUSIONS: TVP may be more effective and safer than TURP for the benign prostatic hyperplasia patient whose prostate volume is >80 mL.

[The effect of prostatectomy on nocturia in patients with benign prostatic hyperplasia].

OBJECTIVE: To explore the effect of prostatectomy on nocturia in patients with benign prostatic hyperplasia (BPH). METHODS: The data of patients who had received prostatectomy for BPH between June 2006 and December 2007 were collected. Nocturia severity was assessed preoperatively and 3 to 6 months after prostatectomy by the number of nocturia events, the time from falling sleep to the first awakening to void (hours of undisturbed sleep, HUS), the score of the nocturia quality of life (N-QOL) questionnaire, the International Prostatic Symptom Score (IPSS) and the quality of life (QOL) score. RESULTS: One hundred and twenty five cases were included. Of them, 73 patients finished the follow-up completely. There were 62 patients whose number of nocturia events before the operation was equal or more than 2. The data from these 62 patients were analyzed. Of them, 56 patients underwent transurethral resection of prostate, the remaining 11 patients suprapubic prostatectomy. Significant improvement (P < 0.01) was noted in all the following parameters after treatment: the number of nocturia events decreased from 4.2 ± 2.4 to 2.2 ± 1.0, HUS increased from (1.8 ± 0.7) h to (3.0 ± 1.4) h, N-QOL score raised from 30 ± 10 to 40 ± 7, IPSS decreased from 23 ± 5 to 8 ± 5, and QOL score fell down from 4.4 ± 0.7 to 1.5 ± 1.0. CONCLUSION: The prostatectomy can markedly improve the symptoms of nocturia, sleep and life quality in the BPH patients who accompanied with nocturia.

Antibacterial therapy improves the effectiveness of prostate cancer detection using prostate-specific antigen in patients with asymptomatic prostatitis.

OBJECTIVES: To improve prostate cancer (PC) detection accuracy among patients with a prostate-specific antigen (PSA) above 4.0 ng/ml and asymptomatic prostate inflammation. MATERIALS AND METHODS: A total of 136 patients with PSA ranging from 4.0 to 50.0 ng/ml with asymptomatic prostatitis were included in the study cohort. All these patients underwent antibacterial therapy for 2 weeks followed by repeat PSA determination and transrectal ultrasound-guided needle prostate biopsy. The PSA, PSAD (PSA density), and f/t PSA (free/total PSA) before and after antibacterial therapy were compared using t-test. The receiver-operating characteristic (ROC) technique was used to evaluate the effectiveness of PSA, PSAD, f/t PSA, and their changes after antibacterial therapy (DeltaPSA, DeltaPSAD, and Deltaf/t PSA) on PC detection. RESULTS: Among the 136 patients, 33 had PC and the other 103 histologically confirmed benign prostatic disease. After antibacterial therapy for 2 weeks, the PSA (mean +/- standard deviation) decreased from 14.0 +/- 7.8 ng/ml to 10.4 +/- 7.7 ng/ml (P < 0.01). The DeltaPSA, DeltaPSAD, and Deltaf/tPSA were -3.60 +/- 4.3 ng/ml, -0.1 +/- 0.1 ng/ml/ml, and -0.1 +/- 0.1 respectively. The areas under ROC curve were 0.29 for PSA, 0.64 for PSAD, and 0.50 for f/t PSA. The areas under ROC curve were 0.91 for DeltaPSA, 0.96 for DeltaPSAD, and 0.98 for Deltaf/t PSA. These values were increased significantly when compared with those for the PSA-related parameters before antibacterial therapy (P value, DeltaPSA, DeltaPSAD, and Deltaf/t PSA were <0.01). CONCLUSIONS: Using the changes in PSA-related parameters after antibacterial therapy DeltaPSA, DeltaPSAD, and Deltaf/t PSA improve the PC detection rate and decrease unnecessary prostate biopsies in patients with asymptomatic prostatitis.

Protective effect of ganoderan on renal damage in rats with chronic glomerulonephritis.

PURPOSE: To investigate the protective effect of ganoderan on renal damage in rat models with chronic glomerulonephritis induced by adriamycin. METHODS: 48 healthy Sprague-Dawley rats were randomly divided into three groups: control, nephritic model and ganoderan treatment groups. Changes of the following indices in the three groups were observed 6 weeks after treatment: 24-hour urine protein, albumen, serum creatinine, cholesterol. Histopathological observations of the renal cortex were made by light and electron microscopy. RESULTS: Compared with controls, levels of 24-hour urine protein (9.60+/-0.57 mg/d vs. 82.50+/-3.18 mg/d), serum creatinine (35.25+/-2.63 micromol/L vs. 44.75+/-8.06 micromol/L) and cholesterol (1.15+/-0.10 mmol/L vs. 4.02+/-0.25 mmol/L) of rats in the nephritic model group were increased (P < 0.05), and the concentration of albumen was decreased (35.98+/-1.34 g/L vs. 19.05+/-0.62 g/L, P < 0.05). Ganoderan administration decreased 24-hour urine protein (82.50+/-3.18 mg/d vs. 45.01+/-3.94 mg/d, P < 0.05). Following ganoderan, the pathological changes in kidney tissue were improved compared with those in the nephritic model group. CONCLUSION: Ganoderan exerts protective effects in rats with chronic glomerulonephritis induced by ADR. Ganoderan reduced 24-hour urine protein, serum creatinine, cholesterol, improving renal function and reducing the severity of renal injury.

cDNA macroarray for analysis of gene expression profiles in prostate cancer.

BACKGROUND: Early diagnosis and timely treatment are important for improving therapeutic efficiency of prostate cancer. DNA array is a new bio-technology for disease diagnosis. This study was conducted to diagnose prostate cancer with cDNA macroarray and analysis gene expression profiles of some selective genes in prostate cancer. METHODS: Total RNA was isolated from patients with prostate cancer and from normal people, and poly (A) RNA was further purified. Then it was analyzed for differentially expressed genes in prostate cancer and normal prostate by cDNA macroarray system. RESULTS: There were different expressions in the nine prostate-associated specific genes in prostate cancer as compared with normal prostate, in which, 7 were significantly upregulated and 2 were down-regulated. CONCLUSION: As a diagnostic approach at molecular level, the cDNA macroarray is an effectively diagnostic method for prostate cancer.

[The therapeutic efficacy for ED patients treated with low dosage of PGE1].

OBJECTIVES: To evaluate the efficacy of intrameatal application of low dosage alprostadil (PGE1) cream (300 mcg) for the treatment of erectile dysfunction (ED). METHODS: A total of 43 ED patients were selected in the study based on the inclusion criteria. All of the patients signed informed consent forms and entered a 4-week open-label clinical study. A dosage of 300 mg PGE1 in 75 mg cream was applied intrameatally. RESULTS: The results showed that the primary efficacy (IIEF Q3 + Q4) reached 70.73% after application of the cream. The successful intercourse rate was 86.41%. Based on the GAQ (global assessment Question); 73.17% of the patients were satisfied with their sexual life. At the same time, all of the secondary criteria supported the primary efficacy results. Two patients withdrew during the study period. Six patients (14.63%) had urethral pain or penile redness, which were mostly mild and transient. CONCLUSIONS: With intrameatal low dosage (300 mcg PGE1) of the PGE1 cream can achieve an equivalent efficacy as that with the full dosage.