Clinical efficacy and complications of transurethral resection of the prostate versus plasmakinetic enucleation of the prostate.

BACKGROUND: Benign prostatic hyperplasia (BPH) is a common disease in elderly males, and many kinds of minimally invasive procedures can be used for the treatment of BPH. However, various procedures have caused some controversies regarding clinical outcomes, so more studies are needed to validate these controversial topics. AIMS: This study aimed to explore differences of clinical efficacy, surgical features, and complications between transurethral resection of the prostate (TURP) and plasmakinetic enucleation of the prostate (PKEP) for BPH. METHODS: A total of eligible 850 cases of BPH underwent TURP (the TURP group, 320 cases) or PKEP (the PKEP group, 530 cases) in the urology department of our hospital from March 2015 to 2018 were involved in this study. Then, the baseline data, surgical characteristics, IPSS, QoL, PVR, Qmax, IIEF-5, and documented complications were compared between the two groups. RESULTS: The operative time, intraoperative irrigation volume, postoperative hemoglobin, decrease in hemoglobin, postoperative irrigation time and volume, catheterization time, and hospital stay of the PKEP group were significantly less than those of the TURP group (all P < 0.05). At 3 months, 1, 2, and 3 years after operation, no significant differences were observed in IPSS, QoL, PVR, but the results of Qmax and IIEF-5 in the PKEP group were significantly higher than those parameters in the TURP group (all P < 0.05). The incidences of massive blood loss, postoperative secondary bleeding, blood transfusion, capsular perforation, urinary tract irritation, bladder spasm, clot retention, urinary tract infection, transient incontinence, erectile dysfunction, and the incidences of II, III grade of Clavien-Dindo classification in the PKEP group were significantly lower than those of the TURP group (all P < 0.05). CONCLUSION: The clinical efficacy of PKEP is compared favorably with TURP during midterm follow-up. Given the merits such as less blood loss and hospital stay, lower complications, PKEP should be given a priority for BPH.

Functional analysis of the TMPRSS2:ERG fusion gene in cisplatin­induced cell death.

The TMPRSS2:E­twenty­six (ETS) gene fusion occurs frequently in a high proportion of patients with prostate cancer (PCa) in Western countries, and the aberrant expression of TMPRSS2: v­ETS avian erythroblastosis virus E26 oncogene homolog (ERG), the most common form of the corresponding protein, can regulate cell migration and contribute to tumor invasion and metastasis. However, its association with other cellular events, and in particular, cell death, remain unknown. To examine the function of such fusion genes, an expression plasmid containing the TMPRSS2:ERG (T1/E5) sequence (ΔERG) from a patient sample was constructed and transiently transfected into DU145 cells, which do not express the fusion gene. It was found that the overexpression of ΔERG significantly inhibited the ability of cisplatin to induce apoptosis in DU145 cells. By contrast, VCaP cells, which do contain TMPRSS2:ERG, were sensitized to cisplatin­induced apoptosis through siRNA inhibition of the fusion gene. To elucidate the underlying mechanism, a stable cell line expressing the ΔERG gene was constructed. Expression of ΔERG did not affect cell migration, but did protect cells from DNA damage and apoptosis induced by cisplatin. Furthermore, knockdown of ΔERG by short interfering RNA resulted in cells regaining their sensitivity to cisplatin. Finally, the gene coding for activating transcription factor 5, which is important for cell survival, may be upregulated by ΔERG. Taken together, these data point to a new function of the TMPRSS2:ERG fusion gene in regulating the apoptotic pathway.

A panel of five circulating microRNAs as potential biomarkers for prostate cancer.

BACKGROUND: Circulating microRNA (miRNAs) have been shown to have the potential as noninvasive diagnosis markers in several types of cancers. In this study, we investigated whether circulating miRNAs could be used in the diagnosis of prostate cancer (CaP) in a Chinese patient population. METHODS: Illumina's Human v2 miRNA microarray was used to analyze miRNAs levels in a small set of patients [25 CaP, 17 benign prostatic hyperplasia (BPH)] in an effort to identify CaP-specific miRNAs. The identified miRNAs were further examined by quantitative real-time PCR (qRT-PCR) in the same small set of patients. After the training phase of screening and selecting, the candidate miRNAs were validated in a larger independent cohort (80 CaP, 44 BPH, and 54 healthy controls) with qRT-PCR in the verification phase. RESULTS: Five miRNAs were confirmed by qRT-PCR analysis in validation sets. Receiver operating characteristic (ROC) curve analysis showed all 5 miRNAs had diagnostic value. More importantly, further principal component analysis indicated component 1 extracted from expression data of the 5 miRNAs could differentiate CaP from BPH and healthy controls with high diagnosis performance, with an AUC of 0.924 and 0.860, respectively. CONCLUSIONS: Our data suggested that circulating miRNAs could serve as biomarkers for CaP, and compared to single miRNA, the 5 miRNAs panel can accurately discriminate CaP from BPH and healthy controls with high sensitivity and specificity, and therefore, combined with routine PSA test, these 5 CaP-specific miRNAs may help improve CaP diagnosis in clinical application.

[The clinical study of 120 cases total cystectomy and W shape orthotopic ileal neobladder].

OBJECTIVE: To study advantages or disadvantages of total cystectomy and W shape orthotopic ileal neobladder. METHODS: Radical cystectomy and ileal new bladder was performed antegradly and retrogradly for 120 male patients. For the construction of the reservoir, the 40 cm ileal segment was isolated along its antimesenteric border and then arranged into a W shape. The incised ileum was sutured blanketly to create urine bag. The ureters were replanted at the two corners of the W shape by way of creating nipple. RESULTS: The first 50 cases took 210-300 min with a mean of 270 min. The later 70 cases took 110-205 min with a mean of 143 min. Ninety-one of 120 cases had been followed up for 2-88 months with a mean of 30 months. Eighty-five cases had achieved excellent daytime continence, whereas 71 cases had nighttime continence. There were 9 cases of hydroureter and 2 cases of moderate hydronephrosis. Renal function of 2 cases were slightly abnormal. Hypokalemia occurred in 6 cases, and there was no metabolic-disorder. On voiding cystography, only 1 case showed reflux in right ureter. Only 2 case suffered from cancer recurrence of urethral and no patient suffered from cancer recurrence of neobladder. Twenty patients were evaluated by urodynamic examine. The urine flow curve showed continual shape in 12 cases, while intermittent shape in 8 cases. Voiding cystourethrography showed the neobladder outlet presented funnel shape and open well in continual group, while lack of funnel shape or bladder neck opened badly in intermittent group. CONCLUSION: The modified total cystectomy and ileal new bladder are effective and reliable treatment for patients.

[Diagnosis and treatment of priapism due to neoplasma of penis].

OBJECTIVE: To improve the clinician's ability for emergency treatment of priapism. METHODS: Both cases received 2 mg to 8 mg of metaraminol injection at the root of cavernous body, and perfusion of heparinized saline at glans and root of cavernous body of the penis by contrecoup, but they had not good response to the above therapy. At last surgery was performed. RESULTS: Total penectomy was performed for both cases. One case was diagnosed of penile sarcoma, and another was metastatic transitional cell carcinoma. CONCLUSION: Priapism due to neoplasma is infrequent, it should not be misdiagnosed in case of emergency.

[Hand-assisted laparoscopic renal surgery: report of 45 cases].

OBJECTIVE: To evaluate the effect and clinical application of hand-assisted laparoscopic renal surgery. METHODS: Forty-five patients with urologic diseases underwent hand-assisted laparoscopic renal surgery: radical nephrectomy was performed on 23 cases, simple nephrectomy on 9 cases, nephroureterectomy on 8 cases, excision of cysts of kidney on 3 cases, partial nephrectomy on 1 case, and upper pole heminephrectomy in duplex kidney on 1 case. The operation was performed by transperitoneal approach in 38 cases and by underwent and by retroperitoneal approach in 7 cases. RESULTS: Hand-assisted laparoscopic renal surgery were performed successfully on all patients. The mean operation time was 154.7 minutes (40 approximately 300 min), and the mean estimated blood loss was 100.4 ml (15 approximately 300 ml). CONCLUSION: With the advantages of minimal invasion, less blood loss, faster recovery, hand-assisted laparoscopic renal surgery is worth popularizing in urologic clinical practice.