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Objective:To investigate the effect of modified holmium laser enucleation of the prostate (HoLEP) in patients with large-volume benign prostatic hyperplasia (BPH), and the effect on urethral function, pain mediators, epidermal growth factor (EGF) and prostate specific antigen (PSA).Methods:The clinical data of 83 patients with large-volume BPH in Dalian Central Hospital from October 2019 to April 2021 were retrospectively analyzed. Among them, 42 patients were treated with modified HoLEP (modified HoLEP group), and 41 patients were treated with transurethral resection of the prostate (TURP; TURP group). The procedure-related indexes (operative time, hospital stay, duration of urinary catheter retention, bladder flushing time and hemoglobin loss) were compared between 2 groups; the serum levels of pain mediators including substance P (SP), prostaglandin E 2 (PGE 2), calcitonin gene-related peptide (CGRP) before surgery and 1, 3 days after surgery were measured; the serum levels of EGF and PSA before surgery and 1, 2 weeks after surgery were measured; postoperative complications were counted; the maximum urinary flow rate, residual urine volume and bladder compliance before surgery and 3, 6 months after surgery were measured to assess urethral function; the improvement of symptoms before surgery and 3, 6 months after surgery were assessed by the overactive bladder symptom score scale, the international prostate symptom score scale and the quality of life index scale. Results:There was no statistical difference in operative time between 2 groups ( P>0.05); the hospital stay, duration of urinary catheter retention and bladder flushing time in modified HoLEP group were significantly shorter than those in TURP group: (4.52 ± 1.07) d vs. (5.74 ± 1.46) d, (2.87 ± 0.72) d vs. (4.84 ± 0.93) d, (18.29 ± 6.75) d vs. (28.54 ± 10.68) d, the hemoglobin loss was significantly lower than that in TURP group: (2.96 ± 0.84) g vs. (13.17 ± 5.69) g, and there were statistical differences ( P<0.01). There were no statistical differences in SP, PGE 2 and CGRP before surgery between 2 groups ( P>0.05); the SP, PGE 2 and CGRP 1 and 3 d after surgery in modified HoLEP group were significantly lower than those in TURP group, and there were statistical differences ( P<0.01). There were no statistical differences in EGF, PSA, urethral function and symptoms improvement before and after surgery ( P>0.05). The incidence of postoperative complications in modified HoLEP group was significantly lower than that in TURP group: 9.52% (4/42) vs. 29.27% (12/41), and there was statistical difference ( P<0.05). Conclusions:Modified HoLEP for the treatment of large-volume BPH patients can effectively reduce the incidence of postoperative complications, further reduce the level of pain mediators, and effectively shorten the postoperative recovery process.
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Objective To assess the efficacy and side effects of intravesical instillation of BCG after transurethral resection of the bladder tumor (TURBT) in non-muscle invasive bladder cancer (NMIBC) patients.Methods The clinical data of patients treated with BCG 120 mg per course induced perfusion or more after TURBT from December 2013 to October 2016 in 18 hospitals of northeast China region,were analyzed retrospectively.The first part,data of 106 patients with moderate,high-risk NMIBC were collected.A total of 83 patients were male,while the other 23 patients were female.The average age was 66.7 years old.The clinical staging were T1 in 86(81.1％) cases,Ta in 20(18.9％) cases and carcinoma in situ in 6 (5.7％) patients.Intravesical instillation of BCG was executed after transurethral resection of the bladder tumor.The incidence rate of recurrence and progression during more than 6 months' follow-up time were observed.Multivariate analyses were done by using logistic analysis and Cox proportional hazards regression model with Kaplan-Meier method.The second part,treatment compliance of 276 patients with bladder cancer,including moderate/high-risk NMIBC in 263 cases,moderate/high-risk NMIBC followed with renal pelvis/ureteral carcinoma in 8 cases were and moderate/high-risk NMIBC with renal pelvis/ureteral carcinoma in 5 cases who treated with BCG after the surgeries,were observed.Patients consisted of 211 males and 65 females with average age of 68.3 years.Results With a median follow-up of 12 months,9 (8.5％) patients experienced tumor recurrence and 2 (1.9％) patients were found progression in the first part.The one-year cancer free recurrence rate of the patients was 91.5％.Statistically significant prognostic factors for recurrence identified by multivariable analyses were prior recurrence of the tumors (OR =3.214,95％CI0.804-12.845,P =0.099).In the second port,an incidence rate of adverse effects was 64.1％ (177/276).The Ⅲ/Ⅳ degree complications were occurred in 11 patients and satisfactory outcomes achieved with active treatment.A total of 36 patients withdrawal with the major causes were recurrence and progression of bladder tumor in 12 cases (4.4 ％),9 cases (3.3 ％) with economic reasons and 11 cases (4.0％) with serious complications.Conclusions NMIBC patients treated with intravesical BCG therapy have approving cancer free recurrence rates and acceptable adverse effects.Prior recurrence may be prognostic factor of recurrence after intravesical BCG therapy.
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Objective To study the efficacy and security of solifenacin in prevention of cystospasm after radical prostatectomy. Methods The clinical data of 93 localized prostate cancer patients who had underwent laparoscopic radical prostatectomy were retrospectively analyzed. The patients were divided into solifenacin group (52 cases) and control group (41 cases) based on the condition of taking solifenacin after operation. The day and night frequency and duration of cystospasm from the first day to the third day after operation, incidence of urine extravasation, duration of bloody urine, time of pelvic cavity drainage and ureter retention, untoward reaction (dry mouth, headache and abdominal distention) was compared between two groups. Results The day and night frequency and duration of cystospasm at second day and third day after operation in solifenacin group were significantly lower than those in control group. Day frequency of cystospasm: (1.54 ± 0.42) times vs. (3.35 ± 0.43) times and (1.38 ± 0.58) times vs. (2.86 ± 0.66) times, night frequency of cystospasm:(1.66 ± 0.63) times vs. (3.58 ± 0.72) times and (1.47 ± 0.33) times vs. (3.27 ± 0.68) times, duration of cystospasm:(0.18 ± 0.11) h vs. (0.33 ± 0.18) h and (0.21 ± 0.09) h vs. (0.29 ± 0.21) h, and the incidence of urine extravasation at the third day after operation in solifenacin group was significantly lower than that in control group: 1.92% (1/52) vs. 17.07% (7/41), and there were statistical differences (P0.05). Conclusions Solifenacin can reduce the frequency of cystospasm and shorten the duration of cystospasm effectively after radical prostatectomy. It has a positive effect on reducing the incidence of urinary extravasation and shorting the extubation time. It is helpful to improve the quality of life and the recovery of the patients.
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Objective To compare the effect of different urethrovesical anastomosis methods on postoperative anastomotic complication in laparoscopic radical prostatectomy (LRP). Methods The clinical method of 121 patients with localized prostate cancer who underwent LRP from June 2012 to June 2015 was retrospectively analyzed. The patients were divided into two groups according to different urethrovesical anastomosis methods: interrupted suture group with 36 patients and continuous suture group with 85 patients. The operation time, postoperative anastomosis leakage, anastomosis stenosis and urinary control status 1, 3 and 6 month after operation were compared between two groups. Results All the operations were completed successfully without converting to open approach. The operating time of continuous suture group and interrupted suture group was (20.35 ± 3.10)min and (34.02 ± 3.94) min, the rate of postoperative anastomosis leakage was 3.53%(3/85) and 16.67%(6/36), the rate of anastomosis stenosis was 2.35%(2/85) and 13.89%(5/36), the rate of urinary incontinence after operation for 1 month was 15.29%(13/85) and 33.33%(12/36), for 3 months was 7.06%(6/85) and 25.00%(9/36), for 6 months was 2.35% (2/85) and 13.89% (5/36), there were significant differences (P<0.05). Conclusions Continuous suture can shorten operation time, decrease the risk of anastomotic leakage, anastomosis stenosis and urinary incontinence.
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Objective To investigate the difficulties of building channel in ultrasound-guided percutaneous nephrolithotomy (PCNL).Methods Surgical processes of 45 patients underwent PCNL were recorded.The difficulties and causes in building channel were analyzed.Results In the process of building channel in PCNL,60 cases of difficulties happened,41.7％ (25/60) because of depth inaccuracy of puncture and dilation,18.3％(11/60) because of angle deviation of tract dilation,15.0％(9/60) result from nondilated collecting system,13.3％(8/60) because of lacking experience in ultrasound observation.Conclusions The most often encountered difficulties is depth inaccuracy of puncture and dilation in building channel,next is angle deviation of tract dilation.To improve technique detailes is the key to gain success.
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Objective To investigate the relationship between nuclear factor(NF)-κB activity and lactacystin induced prostate cancer cell apoptosis.Methods Two prostate cancer cell were divided into two groups:blank control group treated with culture solution,lactacystin group treated with different concentration of lactacystin(0.5,1.0,2.0,4.0 μ mol/L),the action time were 8,16 and 24 hours.The cell survival rate was measured by MTT assay.NF-κB DNA binding activity was measured by enzyme-linked immunosorbent assay,the expression of NF-κB P65 nuclear protein was detected by Western blot assay,and caspase-3 activity was analyzed by enzyme analysis assay.Results On basal condition,the NF-κ B DNA binding activity was much higher in DU145 cell than that in LNCaP cell(t=4.728,P=0.001).Compared with blank control group,different concentration of lactacystin groups'NF-κ B DNA binding activity in both the LNCaP and DU145 cell were reduced.The expression of NF-κB p65 nuclear protein decreased along with raising of lactacystin concentration in LNCaP cell,but it did not change in DU145 cell.On basal condition,caspase-3activity in DU145 cell was higher than that in LNCaP cell(t=4.519,P=0.001).After lactacystin acting of 24 hours,caspase-3 activity increased along with raising of lactacystin concentration in both the LNCaP and DU145 cell(2.0 μmol/L lactacystin group compared with 1.0 μmol/L lactacystin group,DU145 cell P=0.000,LNCaP cell P=0.000).Conclusions Lactacystin has different killing effects on prostate cancer cell.The mechanism may be related to inducing the apoptosis by down-regulation of NF-κB activity.There may be additional cell survival/death pathway in androgen-independent prostate cancer cell.