[Analysis of risk factors of urethral stricture and urinary incontinence after transurethral resection of the prostate].

OBJECTIVE: The purpose of this study was to analyze the risk factors for predicting urethral stricture and urinary incontinence after transurethral resection of the prostate (TURP). METHODS: A retrospective study of 261 patients admitted from October 2018 to October 2022 who received TURP for benign prostatic hyperplasia (BPH) with complete postoperative follow-up data of at least 6 months. Patients were divided into urethral stricture group (n =18), non-urethral stricture group (n =243), urinary incontinence group (n = 12) and non-urethral incontinence group (n = 249) according to the presence of urethral stricture and urinary incontinence. Compared two groups of patient's age, course of the disease, hypertension, diabetes mellitus, IPSS score, prostate volume, maximum urine flow rate, whether preoperative urinary retention, total prostate specific antigen levels and whether preoperative status, placing a urinary catheter preoperative whether merger urinary tract infection, operative time, postoperative time, postoperative urine tube drawing time placing a urinary catheter, etc. Univariate and multivariate Logistic regression analyses were used to screen for independent predictors. RESULTS: The incidence of urethral stricture and urinary incontinence after TURP was 6.9% and 4.6%, respectively. Multivariate logistic regression analysis showed that diabetes mellitus (OR = 9.526, 95%CI: 2.824－32.127, P= 0.000); Preoperative urethral infection (OR = 6.500, 95%CI: 1.513－27.925, P = 0.012); Postoperative indwelling catheter time (OR = 2.063, 95%CI: 1.181－3.601, P = 0.011) was an independent risk factor for postoperative urethral stricture. Age (OR = 1.21, 95%CI: 1.027－1.425, P = 0.023); Diabetes mellitus (OR = 37.515, 95%CI: 2.615－538.170, P = 0.008); Postoperative indwelling catheter time (OR = 20.806, 95%CI: 3.090－140.080, P = 0.002) was an independent risk factor for postoperative urinary incontinence. CONCLUSIONS: Urethral stricture and urinary incontinence are common complications after TURP. Diabetes, preoperative urethral infection, and postoperative catheter indwelling time are independent risk factors for urethral stricture after TURP. Age, diabetes mellitus and postoperative catheter indwelling time were independent risk factors for postoperative urinary incontinence. Diabetes mellitus and postoperative catheter indwelling were common and independent risk factors for urethral stricture and urinary incontinence after TURP.

Surgical Training Improves Performance in Minimally Invasive Left Ventricular Assist Device Implantation Without Cardiopulmonary Bypass.

OBJECTIVE: We introduced a live animal model for training of minimally invasive implantation of a continuous-flow left ventricular assist device (CF-LVAD) without cardiopulmonary bypass for operator's performance improvement. DESIGN: After watching a videotape of LVAD implantation on the beating heart through the cardiac apex, the surgical team performed implantation of LVADs into 5 pigs during 3 training sessions in a time series. The procedure success rate, operating time, and technical and global performances by self-evaluation and senior evaluation were compared among the sessions. SETTING: Animal Experiment Center in Peking University Third Hospital. PARTICIPANTS: Surgical team comprising a surgical operator, surgical assistant, anesthetist, and scrub nurse performed 3 training sessions in a time series. RESULTS: The urgent situations requiring proper management were myocardial laceration, massive blood loss, and ventricular arrhythmia induced by hemodynamic instability. After practice, the success rate increased to 100% in session 3. The operating times of session 2 (189.80 ± 14.34min) and session 3 (149.00 ± 22.85min) were significantly lower than that of session 1 (262.20 ± 28.26min). The technical and global performances by self-evaluation and senior evaluation were significantly better in session 3 than session 1. CONCLUSION: Simulation training with high-fidelity in vivo model for minimally invasive CF-LVAD implantation improves the surgical team's global performance, success rate, and the ability to manage emergency situations in surgery.

[Analysis of surgical treatment of coronary artery disease with mitral regurgitation].

OBJECTIVE: To analyze the effect of combined coronary artery with mitral valve surgery and summarize our clinical experience. METHODS: From August, 2002 to May, 2006, 42 patients underwent combined CABG and mitral valve surgery because of concomitant ischemia myocardium disease and mitral regurgitation (MR) of moderate to severe degree. The etiology of MR was ischemic myocardium disease in 38 (90.48%, 38/42), rheumatic heart disease in 2(4.76%, 2/42)and degenerative valve disease in 2(4.76%, 2/42). Preoperative eject fraction (EF) was 0.20-0.80 (mean 0.41+/-0.14).Of all the patients 12 cases underwent mitral valve replacement and 30 mitral valvuloplasty. RESULTS: After surgery 4 (9.52%,4/42) patients died in hospital. 36 patients were discharged with trivial to mild MR and 2 with moderate MR which had been severe preoperatively. The mean EF shows no significant improvement in discharged patients (0.41+/-0.14 preoperative versus 0.45+/-0.12 postoperative, P=0.152). But in MVP group, significant difference could be found (0.36+/-0.08) preoperative versus 0.41+/-0.10 postoperative, P=0.013). CONCLUSION: Coronary artery disease and mitral valve insufficiency could be effectively corrected by combined CABG and mitral valve procedure. MVP is preferred and annuloplasty ring involvement could ensure effect of operation.

[Local applied slow-releasing rapamycin inhibits neointima hyperplasia in vein graft].

OBJECTIVE: To investigate whether rapamycin (RPM) can reduce the neointima formation in the autologous vein graft, thus to provide support for its clinical application. METHODS: Twenty-four male rabbits were made external jugular vein-to-common carotid artery models and then were divided into 4 equal groups at random: blank-control group; F-127 control group receiving local application of 0.5 ml 20% F-127 around the vein graft; low-dose RPM group, receiving local application of 0.5 ml 20% F-127 containing RPM of 50 microg/cm(2); and high dose RPM group, receiving local application of 0.5 ml 20% F-127 containing RPM of 100 microg/cm2. The rabbits were killed 3 weeks later and the samples of vein graft bridge were taken to undergo light microscopy. The ratio of intima to media thickness and restenosis rate (ratio of lumina to lumina plus intima area) were measured. Immunohistochemistry was used to detect the proliferating cell nuclear antigen (PCNA) positive cells so as to indicate the degree of cell proliferation. The apoptosis cells were detected by TUNEL to indicate the degree of cell apoptosis. RESULTS: The intima thickness levels of the low- and high-dose RPM groups were 29 microm +/- 10 microm and 16 microm +/- 8 microm respectively, both significantly lower than those of the blank-control group and F-127 control group (90 microm +/- 11 microm and 85 microm +/- 11 microm respectively, all P < 0.05). The restenosis rate (lumina area/total area ratio) of the low- and high-dose RPM groups were 0.80 +/- 0.36 and 0.91 +/- 0.13 respectively, both significantly higher than those of the blank-control group and F-127 control group (0.58 +/- 0.11 and 0.65 +/- 0.47 respectively, all P < 0.05). The cell proliferation indicis of vascular smooth muscle cells (VSMCs) of the low- and high-dose RPM groups were 20% +/- 9% and 14% +/- 6% respectively, both significantly lower than those of the blank-control group and F-127 control group (31% +/- 7% and 35% +/- 6%, all P < 0.05). The cell apoptosis indicis of the low- and high-dose RPM groups were 33% +/- 7% and 36% +/- 7% respectively, both significantly lower than those of the blank-control group and F-127 control group (16% +/- 6% and 18.% +/- 8% respectively, all P < 0.05). CONCLUSION: Local delivery of slow-releasing RPM by F-127 effectively inhibits the neointima hyperplasia in vein graft by a mechanism of reducing the VSMC proliferation and inducing cell apoptosis.