Clinical practice guideline for transurethral plasmakinetic resection of prostate for benign prostatic hyperplasia (2021 Edition).

Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline "2018 Standard Edition". However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons' surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy; the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons' skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.

[Deep dorsal vein complex ligation-free technique in robot-assisted radical prostatectomy for prostate cancer].

OBJECTIVE: To investigate the application of the deep dorsal vein complex (DVC) ligation-free technique in robot-assisted radical prostatectomy (RARP) and its effects on the intraoperative blood loss, incidence of positive surgical margin (PSM) and urinary continence of the patient. METHODS: Totally 154 PCa patients underwent RARP between October 2015 and June 2019, 40 with the DVC ligation-free technique (group A) and the other 114 by conventional DVC ligation (group B). We compared the baseline characteristics, operation time, intraoperative blood loss, blood transfusion rate, and postoperative incidences of PSM and urinary incontinence immediately and at 1 and 3 months after catheter removal between the two groups. RESULTS: There were no statistically significant differences between the groups A and B in age, body mass index, PCa risk levels or American Scoiety of Anesthesiology (ASA) tumor grades (P > 0.05), nor in intraoperative blood loss (ΔZ: ï¼»2.11 ± 8.88ï¼½ vs ï¼»1.24 ± 14.70ï¼½ g/L, P > 0.05), blood transfusion rate (10.0% vs 15.8%, P > 0.05), overall PSM incidence (15.0% vs 15.8%, P > 0.05) or apical PSM rate (7.5% vs 8.8%, P > 0.05). The mean operation time was remarkably shorter in group A than in B (107.20 min vs 113.25 min, P < 0.05) and the postoperative incidence rate of urinary incontinence was markedly lower in the former than in the latter group immediately after (2.5% vs 17.5%, P < 0.05) and at 1 month after catheter removal (0 vs 14.0%, P < 0.05), but with no statistically significant difference between the two groups at 3 months (0 vs 7.9%, P > 0.05). CONCLUSIONS: The DVC ligation-free technique in RARP can reduce the operation time and promote the recovery of urinary continence in PCa patients without increasing intraoperative blood loss and the incidence of PSM.

The role of radical prostatectomy and definitive external beam radiotherapy in combined treatment for high-risk prostate cancer: a systematic review and meta-analysis.

The first-line treatment options for high-risk prostate cancer (PCa) are definitive external beam radiotherapy (EBRT) with or without androgen deprivation therapy (ADT) and radical prostatectomy (RP) with or without adjuvant therapies. However, few randomized trials have compared the survival outcomes of these two treatments. To systematically evaluate the survival outcomes of high-risk PCa patients treated with EBRT- or RP-based therapy, a comprehensive and up-to-date meta-analysis was performed. A systematic online search was conducted for randomized or observational studies that investigated biochemical relapse-free survival (bRFS), cancer-specific survival (CSS), and/or overall survival (OS), in relation to the use of RP or EBRT in patients with high-risk PCa. The summary hazard ratios (HRs) were estimated under the random effects models. We identified heterogeneity between studies using Q tests and measured it using I2 statistics. We evaluated publication bias using funnel plots and Egger's regression asymmetry tests. Seventeen studies (including one randomized controlled trial [RCT]) of low risk of bias were selected and up to 9504 patients were pooled. When comparing EBRT-based treatment with RP-based treatment, the pooled HRs for bRFS, CSS, and OS were 0.40 (95% confidence interval [CI]: 0.24-0.67), 1.36 (95% CI: 0.94-1.97), and 1.39 (95% CI: 1.18-1.62), respectively. Better OS for RP-based treatment and better bRFS for EBRT-based treatment have been identified, and there was no significant difference in CSS between the two treatments. RP-based treatment is recommended for high-risk PCa patients who value long-term survival, and EBRT-based treatment might be a promising alternative for elderly patients.

Role of tumor-associated immune cells in prostate cancer: angel or devil?

Prostate cancer is the most common malignancy in the reproductive system of older males. Androgen deprivation therapy (ADT) is an important treatment for prostate cancer patients. However, almost all prostate cancer patients unavoidably progress to the castration-resistant stage after ADT treatment. Recent studies have shown that tumor-associated immune cells play major roles in the initiation, progression, and metastasis of prostate cancer. Various phenotypes of tumor-associated immune cells have tumor-promoting or antitumor functions mediated by interacting with tumor cells. Here, we review the current knowledge of tumor-associated immune cells in prostate cancer.

The evaluation of monocyte lymphocyte ratio as a preoperative predictor in urothelial malignancies: a pooled analysis based on comparative studies.

In recent years, several studies have reported monocyte lymphocyte ratio (MLR) to predict prognosis in various tumors. Our study was performed to evaluate the association between preoperative MLR between prognostic variables in urothelial carcinoma patients. Systematic literature search was conducted in PubMed, Embase, Web of science. The correlation between preoperative MLR and overall survival (OS), cancer specific survival (CSS), disease free survival (DFS)/relapse free survival (RFS), progression free survival(PFS) was evaluated in urothelial carcinoma patients. Meanwhile, the association between MLR and clinicopathological characteristics was assessed. Finally, 12 comparative studies comprising a total of 6209 patients were included for pooled analysis. The hazard ratios (HRs), odds ratios (ORs)and 95% confidence intervals (CIs) were further analyzed as effect measures. The pooled results demonstrated that elevated preoperative MLR indicated unfavorable OS (HR = 1.29, 95%CI = 1.18-1.39, I2 = 33.6%), DFS/RFS (HR = 1.42, 95%CI = 1.30-1.55, I2 = 0.0%) and CSS (HR = 1.41, 95%CI = 1.29-1.52, I2 = 0.0%). Moreover, the pooled results also suggested that elevated preoperative MLR was correlated with high tumor stage (OR = 1.22, 95%CI = 1.07-1.37, I2 = 0.0%) in urothelial carcinoma patients. No significant association was found between preoperative MLR and PFS in upper urinary tract urothelial carcinoma (UUTUC) patients. Collectively, elevated preoperative MLR predicted poor prognosis in urothelial carcinoma and have the potential to be a feasible and cost-effective prognostic predictor for management of urothelial carcinoma.

Curcumin Suppresses microRNA-7641-Mediated Regulation of p16 Expression in Bladder Cancer.

Bladder cancer has a high recurrence rate and requires adjuvant intravesical management after surgery. The use of traditional agents for bladder cancer therapy is constrained by their toxicity and limited efficacy. This emphasizes the need for the development of safer, more effective compounds such as instillation agents. Curcumin is the major component of turmeric, the powdered root of Curcuma longa, which is known for its anti-inflammatory, anti-oxidant and anticancer properties. First, a microarray profiling and qPCR analysis were conducted in the T24 and SV-HUC-1 cell lines. Then, we examined the potential tumorigenicity of miR-7641 in the T24 and SV-HUC-1 cell lines with or without curcumin. Western blot analysis showed that p16 is a target of miR-7641 in T24 cells. We found that, for the first time, curcumin directly downregulates a tumor-promoting microRNA (miRNA), miR-7641, in bladder cancer, which has tumor-promoting characteristics. Curcumin induces the downregulation of miR-7641 and subsequent upregulation of p16 which is a target of miR-7641 at the post-transcriptional level, which leads to the decreased invasion and increased apoptosis of bladder cancer cells. This is the first report to show a direct effect of curcumin on inducing changes in a miRNA suppressor with direct anticancer consequences in bladder cancer. Our study shows that curcumin may be a candidate agent for the clinical management of non-muscle-invasive bladder cancer.

[Prevention and treatment of erectile dysfunction after prostatectomy: An update].

Prostate cancer has the highest incidence among malignant tumors of the urinary system in China. Radical prostatectomy (RP) is the most effective treatment for localized prostate cancer with a good long-term prognosis. Erectile dysfunction (ED) is a common complication after RP, which seriously affects the patient's quality of life. With the rising incidence and early diagnosis of prostate cancer, the proportion of young cases of RP is increasing, and so is the importance of the treatment of post-RP ED. The restoration of erectile function after RP is closely related to the timing of penile rehabilitation as well as to pre- and intra-operative measures such as surgical strategies and methods. Common options for the treatment of post-RP ED include oral medication of phosphodiesterase type 5 inhibitors, application of vasoactive substances in the urethra or corpus cavernosum, use of vacuum erection devices, and implantation of penile prosthesis. Stem cell therapy, nerve transplantation, low-intensity extracorporeal shockwave therapy, and erythropoietin have shown great potential in penile rehabilitation after RP. At present, the stress is placed on the remission of symptoms in the treatment of ED. Stem cell therapy may reverse the cause of disease or cure ED by reversing its pathophysiological changes. A series of clinical trials of stem cell therapy are underway and have preliminarily confirmed the safety of stem cell therapy and proved that it can improve erectile function in patients with post-RP ED. This review focuses on the progress in the prevention and treatment of ED after RP.

[Phloroglucinol combined with parecoxib for cystospasm after transurethral resection of the prostate].

Objective: To evaluate the effect and safety of phloroglucinol combined with parecoxib on cystospasm after transurethral resection of the prostate (TURP). METHODS: We conducted a prospective randomized case-control study on 98 patients treated by TURP. After operation, the patients were randomly assigned to a treatment (n=50) and a control group (n=48), the former treated by intravenous injection of 80 mg phloroglucinol qd plus 40 mg parecoxib bid while the latter given 80 mg phloroglucinol only, both for 3 successive days. Then we recorded the frequency and duration of cystospasm, visual analogue scales (VAS), adverse reactions, post-operative bladder irrigation time, catheter-indwelling time, and hospital stay and compared them between the two groups of patients. RESULTS: Compared with the controls, the patients in the treatment group showed a significantly lower frequency of cystospasm (ï¼»1.95±0.14ï¼½ vs ï¼»0.70±0.65ï¼½ times, P<0.01), duration of cystospasm (ï¼»0.44±0.21ï¼½ vs ï¼»0.12±0.14ï¼½ min, P<0.01), and VAS score (2.70±1.80 vs 1.90±1.30, P<0.01) at 48－72 hours after TURP, but no statistically significant differences were found between the control and treatment groups in the post-operative bladder irrigation time (ï¼»2.75±0.87ï¼½ vs ï¼»2.64±0.83ï¼½ d, P>0.05), catheter-indwelling time (ï¼»3.52±0.32ï¼½ vs ï¼»3.44±0.42ï¼½ d, P>0.05), and hospital stay (ï¼»5.23±0.81ï¼½ vs ï¼»5.10±0.73ï¼½ d, P>0.05), and no obvious adverse reactions were observed in either of the two groups. CONCLUSIONS: Phloroglucinol combined with parecoxib is more effective and safer than phloroglucinol alone in relieving postoperative cystospasm after TURP.

[Safety and effectiveness of GreenLight 120-W laser photoselective vaporization of the prostate for benign prostatic hyperplasia: A meta-analysis].

OBJECTIVE: To evaluate the safety and effectiveness of GreenLight 120-W laser photoselective vaporization of the prostate (PVP) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). METHODS: We searched PubMed, Medline, Embase, Cochrane Library, Wanfang, CNKI, and VIP for randomized control trials and their references addressing 120-W PVP versus TURP in the treatment of BPH. Based on the inclusion and exclusion criteria, two reviewers independently accomplished the screening, quality assessment, and data extraction of the identified studies and performed meta-analyses using RevMan 5.2. RESULTS: Totally, 6 randomized control trials were included in this analysis, involving 703 cases, 351 treated by PVP and 352 by TURP. Compared with TURP, PVP showed significantly decreased time of catheterization (by 32. 55 hours, 95% CI 15.3 -49.8, P < 0.01), hospital stay (by 1.85 days, 95% CI 1.2-2.5, P < 0.01), and intraoperative blood loss (by 15.6 g/L, 95% CI 10.0-21.2, P < 0.01), but increased time of operation (by 9.37 minutes, 95% CI 5. 1-13.6, P < 0.01). There was also a significant reduction in blood transfusion, TUR syndrome, and capsular perforation in the PVP group. At 12 months after surgery, no statistically significant differences were found between the two groups in the improvement of maximum urinary flow rate, IPSS, postvoid residual, and sexual function. CONCLUSION: GreenLight 120-W laser PVP is a safe and effective procedure for the treatment of BPH, with similar effectiveness to TURP but less blood loss, shorter time of catheterization and hospital stay, and lower incidences of blood transfusion, TUR syndrome and capsular perforation.

Primary extragastrointestinal stromal tumor of the seminal vesicles.

Primary tumors originating from the seminal vesicles are extremely rare. We report a unique, previously unreported primary extragastrointestinal stromal tumor (EGIST) of the seminal vesicles in a 40-year-old man.

[Effect of PI3K/AKT inhibitor on benign prostate hyperplasia and its mechanism: an experimental study].

OBJECTIVE: To explore the effect of the phosphoinositide 3-kinase/protein kinase B (PI3K/PKB or PI3K/AKT) signaling pathway inhibitor on benign prostate hyperplasia (BPH) and its mechanism. METHODS: Forty-eight SD male adult rats aged 12 weeks were equally randomized to 4 groups: sham operation control, BPH model, 50 mg LY294002 and 100 mg LY294002. The BPH models were made by muscular injection of testosterone propionate at 10 mg/kg/d for 30 days following castration. The LY294002 groups were treated with the PI3K/AKT signaling pathway inhibitor LY294002 at 50 and 100 mg/kg every other day for 30 days. The prostates of the rats were weighed and the structural changes of the prostatic histiocytes observed under the light microscope. The expressions of Ki-67, anti-apoptotic Bcl-2 and apoptotic Bax were detected by immunohistochemistry, and the apoptosis of prostatic cells determined by terminal de-oxynucleotidyl transferase-mediated dUTP nick end labeling. RESULTS: The prostate wet weight and prostatic index were (551 +/- 10.8) mg and 1.61 +/- 0.05 in the sham operation group, (687 +/- 13.8) mg and 2.15 +/- 0.12 in the BPH model group, (623 +/- 23.5) mg and 1.95 +/- 0.11 in the LY294002 50 mg group (P < 0.05 versus the BPH models) and (561 +/- 12.6) mg and 1.71 +/- 0.18 in the LY294002 100 mg group (P < 0.01 versus the BPH models). The expressions of apoptotic Bax and anti-apoptotic Bcl-2 were 16.7% and 16.7% in the sham operation group, 16.7% and 58.3% in the BPH model group, 33.3% and 33.3% in the LY294002 50 mg group (P < 0.05 versus the BPH models), and 50.0% and 25.0% in the LY294002 100 mg group (P < 0.01 versus the BPH models). The proliferative and apoptotic indexes were 14.2 +/- 6.4 and 6.5 +/- 1.8 in the epithelial and 7.6 +/- 2.6 and 2.5 +/- 0.3 in the interstitial tissue of the sham operation group, 50.9 +/- 12.8 and 2.7 +/- 1.4 in the epithelial and 16.5 +/- 5.7 and 1.3 +/- 0.8 in the interstitial tissue of the BPH models, 32.0 +/- 13.8 and 6.2 +/- 2.5 in the epithelial and 12.1 +/- 3.8 and 1.6 +/- 1.1 in the interstitial tissue of the LY294002 50 mg group (P < 0.05 versus the BPH models), and 17.8 +/- 14.7 and 7.4 +/- 3.6 in the epithelial and 9.5 +/- 3.4 and 2.2 +/- 1.3 in the interstitial tissue of the LY294002 100 mg group (P < 0.01 versus the BPH models). CONCLUSION: The increased proliferation and decreased apoptosis of prostatic cells in the BPH animal models might be involved in the development and progression of BPH. The PI3K/AKT signaling pathway plays an important role in the development of BPH, which could be inhibited by blocking the PI3K/AKT signaling pathway.

[Diagnosis and treatment of rare mixed prostatic carcinoma].

OBJECTIVE: To discuss the diagnosis and treatment of rare mixed prostatic carcinoma. METHODS: We retrospectively analyzed the clinical data of 6 cases of mixed prostatic tumor confirmed by surgery or transrectal ultrasound guided prostate biopsy, and reviewed the related literature. RESULTS: Three of the patients (2 with mixed small cell carcinoma and adenocarcinoma and 1 with adenosquamous carcinoma of the prostate) underwent palliative transurethral electrovaporization of the prostate (TUVP) and endocrine therapy, but all died within 7 - 10 months. The other 3 (2 with adenosquamous carcinoma and 1 with carcinosarcoma of the prostate) received cystoprostatectomy, urinary diversion, pelvic lymphadenectomy and radiation therapy, and survived for more than 12 months, with 2 of them still under the follow-up observation. CONCLUSION: Mixed prostatic carcinoma behaves aggressively with poor prognosis, of which the diagnosis relies on meticulous pathological examination and immunohistochemical techniques, and the most effective treatment is radical surgery.