[Analysis of risk factors for urinary continence after radical prostatectomy].

OBJECTIVE: There are many causative factors for the occurrence of post-prostatectomy incontinence. Objective clinical characteristics, surgical techniques and pelvic floor muscle therapy are the most important ones. The present study was to identify the risk factors associated with urinary incontinence after radical retropubic prostatectomy (RRP). METHODS: A total of 263 patients were recruited for this multivariate analysis. After a close follow-up, a series of pre-, peri- and post-operative factors were recorded and analyzed. RESULTS: Urinary continence after radical prostatectomy was 14.8% at 4 weeks and 94.7% at 16 weeks. The most important recovery interval for urinary continence was 4 - 16 weeks post-operation. Multivariate analysis revealed that age (P = 0.015), blood transfusion (P = 0.017), previous TURP (transurethral resection of the prostate) (P = 0.006) and neoadjuvant hormonal therapy (P = 0.005) were the important risk factors for urinary incontinence. CONCLUSION: During RRP, optimized preservation of urethral rhabdosphincter length, nerve sparing and early postoperative functional exercises can improve the recovery of urinary continence. Age, blood transfusion and previous TURP are the independent prognostic factors. Neoadjuvant hormonal therapy may improve urinary continence through increasing the preoperative length of membranous urethra.

[The study of electrical acupuncture stimulation therapy combined with pelvic floor muscle therapy for postprostatectomy incontinence].

OBJECTIVE: To explore the effectiveness and significance of whether electrical acupuncture stimulation combining with pelvic floor muscle therapy (PFMT) can improve the recovery of urinary continence. METHODS: A total of 109 patients took part in the study of novel combination treatment for urinary continence from September 2008 to September 2009. Patients were divided into study group (n = 40) and control group (n = 69). The patients in study group received electrical acupuncture stimulation therapy combined with PFMT one week after removal the catheter. The patients in control group performed PFMT as the only treatment for post prostatectomy incontinence. The patients were followed up closely, with their clinical characteristics recorded, questionnaires of ICI-Q-SF filled up, and all the data for statistical analysis collected. RESULTS: There was a significant difference between the study group and the control group in the urinary control curve (P = 0.029). The difference of continence probability between these two groups became greater from 4 weeks after surgery, and the difference reached the peak at 6 weeks (P = 0.023). Then the difference became smaller, and there was no difference at 16 weeks after surgery. ICI-Q-SF questionnaires showed the same results. CONCLUSION: Electrical acupuncture stimulation therapy combining with PFMT can improve the recovery of patients' urinary continence after radical prostatectomy.

[The survival analysis of metastatic prostate cancer].

OBJECTIVES: To analyze the clinical and pathological informations of metastatic prostate cancer patients to find the predictive factors of the survival. METHODS: To filter 364 cases of metastatic prostate cancer in the 940 cases of prostate cancer that were treated in Cancer Hospital Fudan University in Shanghai from March 1998 to June 2009, the cases had hormonal therapy and full clinical and pathological records. All the 364 cases were followed up and the clinical and pathological informations were analyzed, to find the predictive factors that related to the prognosis. Statistic software SPSS 15.0 was used for analysis. Cumulative survival was analyzed by the method of Kaplan-Meier. Cox regression was used for univariate and multivariate analysis. Log-rank method was used for the significance test. RESULTS: The last follow-up date was 30th June 2009 and the median follow-up time was 24 months. At the final follow-up, 240 cases were alive, 109 cases were dead and 15 cases were lost to follow up. The median survival time of metastatic prostate cancer was 64 months, and the one-year, two-year, three-year, four-year, five-year survival rate was 92%, 78%, 66%, 60%, 54%. The univariate analysis indicated that Gleason score (P = 0.033), clinical stage (P < 0.001), the effectiveness of hormonal therapy (P < 0.001), the prostate specific antigen (PSA) nadir during hormonal therapy (P < 0.001) and the time from the start of hormonal therapy to the PSA nadir (P = 0.002) were predictive factors for the survival time of metastatic prostate cancer. The multivariate analysis indicated that the PSA nadir during hormonal therapy (P < 0.001) and the time from the start of hormonal therapy to the PSA nadir (P < 0.001) were independent factors that predict the survival time of metastatic prostate cancer. CONCLUSION: The PSA nadir during hormonal therapy and the time from the start of hormonal therapy to the PSA nadir are independent factors that predict the survival time of metastatic prostate cancer.

Multiple imaging modality-guided radiofrequency ablation combined with transarterial chemoembolization for hepatocellular carcinoma in special locations.

PURPOSE: We aimed to evaluate the safety and effectiveness of radiofrequency ablation (RFA) combined with transarterial chemoembolization (TACE) guided by multiple imaging modalities for hepatocellular carcinomas (HCCs) in special (i.e., high-risk or unfavorable) locations compared with those in conventional locations. METHODS: A total of 122 HCC patients were enrolled, including 85 patients (69.7%) with HCC in conventional locations and 37 (30.3%) with HCC in special locations. The clinical data, overall survival (OS), progression-free survival (PFS), and procedure-related adverse events were analyzed. RESULTS: RFA combined with TACE was successfully performed in all patients. Three complications (2.5%) occurred, with no significant difference between the conventional (n=1, 1.2%) and special (n=2, 5.4%) locations (P = 0.218). Complete tumor necrosis rate was not significantly different between the conventional (n=73, 85.9%) and special (n=34, 91.9%) locations at one-month imaging (P = 0.353). After a follow-up of 3-48 months, the PFS was 17 months for patients with HCC in conventional locations and 14 months for patients with HCC in special locations; one-year PFS rate was 68.1% in the conventional location group, not significantly (P = 0.741) different from 59.1% in the special location group. The OS was 28 months in the conventional location group while 32 months in the special location group. The cumulative one- and two-year OS rates were 89.9% and 63.3%, respectively, in the conventional location group, not significantly different from 96.3% and 65% in the special location group (P = 0.273). Age (P = 0.043) and tumor size (P < 0.001) were significant prognostic factors for OS, and tumor size (P < 0.001) was the only significant prognostic factor for PFS. CONCLUSION: RFA guided by multiple imaging modalities combined with TACE may be safe and effective for treating HCCs in special locations.

[The survival analysis of the advanced metastatic castration-resistant prostate cancer].

OBJECTIVE: To analyze predictive factors of advanced metastatic castration-resistant prostate cancer. METHODS: From December 1996 to March 2008, 250 cases of advanced metastatic prostate cancer progressed into the stage of hormonal independent prostate cancer. The last follow-up date was 31 March 2008 and the median follow-up time was 24 months. During the follow-up, 131 cases were alive, 105 cases were dead and 14 cases were lost to follow-up. Clinical and pathological information of the cases was analyzed to find the predictive factors that related to the prognosis. RESULTS: The median survival time of advanced metastatic castration-resistant prostate cancer was 30 months, and the one-year, two-year, three-year survival rate was 79%, 59%, and 41%. The univariate analysis indicated that prostate specific antigen (PSA) at diagnosis, clinical stage, the PSA nadir during hormonal therapy, the time form the start of hormonal therapy to the PSA nadir, the time of response duration during hormonal therapy, PSA velocity (PSAV) and PSA doubling time (PSADT) at the emergency of castration-resistant prostate cancer, age and PSA at the diagnosis of castration-resistant prostate cancer were factors that predicted the survival time of advanced metastatic castration-resistant prostate cancer. The multivariate analysis indicated that the PSA nadir during hormonal therapy, the time form the start of hormonal therapy to the PSA nadir, PSAV at the emergency of castration-resistant prostate cancer, the time of response duration during hormonal therapy were independent factors that predicted the survival time of advanced metastatic castration-resistant prostate cancer. CONCLUSION: The PSA nadir during hormonal therapy, the time form the start of hormonal therapy to the PSA nadir, PSAV at the emergency of castration-resistant prostate cancer and the time of response duration during hormonal therapy are independent factors that predict the survival time of advanced metastatic castration-resistant prostate cancer.