Correlation between the incidence of inguinal hernia and risk factors after radical prostatic cancer surgery: a case control study.

OBJECTIVE: The incidence of recurrent hernia after radical resection of prostate cancer is high, so this article discusses the incidence and risk factors of inguinal hernia after radical resection of prostate cancer. METHODS: This case control study was conducted in The First People's Hospital of Huzhou clinical data of 251 cases underwent radical resection of prostate cancer in this hospital from March 2019 to May 2021 were retrospectively analyzed. According to the occurrence of inguinal hernia, the subjects were divided into study group and control group, and the clinical data of each group were statistically analyzed, Multivariate Logistic analysis was performed to find independent influencing factors for predicting the occurrence of inguinal hernia. The Kaplan-Meier survival curve was drawn according to the occurrence and time of inguinal hernia. RESULTS: The overall incidence of inguinal hernia after prostate cancer surgery was 14.7% (37/251), and the mean time was 8.58 ± 4.12 months. The average time of inguinal hernia in patients who received lymph node dissection was 7.61 ± 4.05 (month), and that in patients who did not receive lymph node dissection was 9.16 ± 4.15 (month), and there was no significant difference between them (P > 0.05). There were no statistically significant differences in the incidence of inguinal hernia with age, BMI, hypertension, diabetes, PSA, previous abdominal operations and operative approach (P > 0.05), but there were statistically significant differences with surgical method and pelvic lymph node dissection (P < 0.05). The incidence of pelvic lymph node dissection in the inguinal hernia group was 24.3% (14/57), which was significantly higher than that in the control group 11.8% (23/194). Logistic regression analysis showed that pelvic lymph node dissection was a risk factor for inguinal hernia after prostate cancer surgery (OR = 0.413, 95%Cl: 0.196-0.869, P = 0.02). Kaplan-Meier survival curve showed that the rate of inguinal hernia in the group receiving pelvic lymph node dissection was significantly higher than that in the control group (P < 0.05). CONCLUSION: Pelvic lymph node dissection is a risk factor for inguinal hernia after radical resection of prostate cancer.

[Application of a modified vascular blocking technique in intrafascial nerve-sparing laparoscopic radical prostatectomy].

OBJECTIVE: To investigate the clinical effect of a modified vascular blocking technique in intrafascial nerve-sparing laparoscopic radical prostatectomy (INLRP). METHODS: We retrospectively studied the clinical data on 13 cases of INLRP completed via a modified vascular blocking technique between July 2021 and August 2022. The patients ranged in age from 64 to 73 (68.8 ± 3.15) years, with elevated PSA of 4.71－16.12 (9.71 ± 3.50) µg/L preoperatively. Prostate cancer was confirmed in all the cases by ultrasound-guided perineal prostate needle biopsy, with Gleason 6 in 7 cases and Gleason 7 in 6 cases. MRI revealed no preoperative tumor breakthrough in the prostatic capsule or pelvic lymph node metastasis. All the patients received INLRP with a modified superficial suture dorsal vein complex (DVC) combined with lateral prostatic pedicle vascular blocking. RESULTS: Prostatic capsule rupture occurred in 1 case during the operation, with positive resection margin indicated by rapid intraoperative frozen biopsy, so the lateral fascia resection was modified. No positive resection margin was found in any of the cases in postoperative pathological examinations. Urinary continence was restored in 8 cases immediately after surgery and in the other 5 within 2 weeks after catheter removal. At 1 month after surgery, all the patients were medicated with low-dose tadalafil (5 mg qd), and IIEF-5 scores of >15 were achieved in 4 cases (31%) at 1 month and in another 8 (62%) at 3 months postoperatively. CONCLUSION: INLRP via modified vascular blocking showed the advantages of desirable intraoperative bleeding control and postoperative tumor control, restoration of urinary continence and relatively satisfactory recovery of erectile function. However, due to the small sample size, short follow-up time and lack of control, our findings need to be further verified by more clinical studies.

[Entecavir improves the reproductive function of male patients with chronic hepatitis B].

OBJECTIVE: To study the effect of entecavir on the reproductive function of male patients with chronic hepatitis B (CHB). METHODS: This study included 56 CHB male patients (aged 18－45 ï¼»33.14 ± 5.38ï¼½ years) initially treated with entecavir at 0.5 mg/d for 24 weeks from 2015 to 2018 and another 24 healthy fertile male volunteers (aged 21－45 ï¼»32.62 ± 5.94ï¼½ years) as normal controls. We obtained the body mass index (BMI), reproductive hormone levels, semen parameters and IIEF-5 scores from the subjects and compared them between the two groups before and after treatment. RESULTS: There were no statistically significant differences between the CHB and normal control groups in age, BMI, lifestyle and baseline reproductive hormone levels except in the levels of FSH (ï¼»3.92 ± 1.29ï¼½ vs ï¼»3.08 ± 0.85ï¼½ mIU/ml, P = 0.003) and E2 (ï¼»35.79 ± 7.49ï¼½ vs ï¼»28.25 ± 7.09ï¼½ pg/ml, P < 0.01). The semen parameters were significantly lower in the CHB patients than in the normal controls, including total sperm motility (ï¼»37.75 ± 13.33ï¼½% vs ï¼»49.58 ± 9.27ï¼½%, P = 0.004), the percentage of progressively motile sperm (PMS) (ï¼»30.70 ± 10.03ï¼½% vs ï¼»42.46 ± 8.90ï¼½%, P < 0.01), sperm concentration (ï¼»51.51 ± 19.50ï¼½ vs 70.33 ± 30.62) ×106/ml, P = 0.007), and total sperm count (ï¼»160.2 ± 51.8ï¼½ vs ï¼»225.91 ± 97.97ï¼½ ×106, P = 0.002), and so were the IIEF-5 scores (19.32 ± 2.34 vs 21.25 ± 2.35, P = 0.0006). After 24 weeks of entecavir treatment, the CHB patients showed no significant difference from the baseline in the semen volume, semen pH and days of abstinence, but remarkable improvement in total motility (ï¼»37.75 ± 13.33ï¼½ vs ï¼»44.1 ± 11.89ï¼½%, P = 0.004), PMS (ï¼»30.70 ± 10.03ï¼½ vs ï¼»38.30 ± 7.42ï¼½%, P < 0.01), sperm concentration (ï¼»51.51 ± 19.50ï¼½ vs ï¼»62.00 ± 24.64ï¼½ ×106/ml, P = 0.007), total sperm count (ï¼»160.21 ± 51.8ï¼½ vs ï¼»207.65 ± 81.69ï¼½ ×106, P = 0.0002), and IIEF-5 score (20.13 ± 1.82 vs 19.32 ± 2.34, P = 0.02). CONCLUSIONS: CHB patients have lower sexual function and semen quality than normal males. Entecavir can significantly improve the liver function, sexual function and semen quality of the CHB patients, but whether it directly improves the sexual function and semen quality of the patients or indirectly through liver function improvement needs to be further studied.