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Objective To investigate the preoperative magnetic resonance imaging (MRI)examination of the distribution of neurovascular bundles (NVB) around the prostatic capsule,and its clinical value in the nerve-sparing laparoscopic radical prostatectomy (NS-LRP).Methods The clinical data of 42 patients with clinically localized prostate cancer who were admitted from January 2008 to January 2017 were retrospectively analyzed.Age ranged from 58 to 74 years,with an average of 68 years.Preoperative serum PSA range from 0.94 to 12.28 ng/dl,with an average of 7.01 ng/dl.Preoperative Gleason score range from 6 to 8,with an average of 6.Clinical stage:T1-T2 37 cases,T3 5 cases.The average preoperative International Erectile Function Index questionnaire-5 (IIEF-5) 21,of which 23 cases had normal erectile function (IIEF-5 ＞ 22).All the 42 patients underwent MRI examination before operation.According to the distribution of NVB around the prostatic capsule,they were divided into 3 groups:17 cases in group A,and no NVB was evident in all cases.In group B,8 cases were visible but not obvious.In group C,17 cases were evident NVB.There was no significant difference in age,preoperative serum PSA and Gleason score between the three groups (P ＞ 0.05).The preoperative IIEF-5 in group A,B,and C were 19.5,22.8,and 21.5,respectively,with no statistically significant difference (P ＞ 0.05).All 42 cases received NS-LRP under general anesthesia.The differences in IIEF-5 before and after surgery were compared between the three groups.Results In this study,42 cases were successfully completed.42 patients were followed up for 12 to 36 months,with an average of 14.1 months.In group A,B,and C,postoperative IIEF-5 was 8.0,14.1,and 15.5,respectively,which was statistically significant compared with preoperative values (P ＜ 0.05).The decrease of IIEF-5 afteroperation in group A was significantly different from that of group Band C (P ＜0.05).Conclusions Compared with patients with visible NVB on MRI examination,patients have no visible NVB observed on MRI with erectile function-related nerves around the prostatic capsule may be walking on both sides of the prostatic capsule and spreading over the entire anterior ventral surface of the prostate.To maxium-preserve NVB and postoperative erectile function to the utmost,NS-LRP surgery should be more accurately dissected on both sides and ventral side of the prostatic capsule.
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Objective To explore the efficacy of four-step method for transurethral enucleation of the prostate . Methods A retrospective analysis was conducted on 120 cases of benign prostate hyperplasia ( BPH) treated with four-step method ( traction, enucleation, resection, and repair ) for transurethral plasmakinetic resection of the prostate in our hospital from January 2012 to February 2014. Results The average operation time was (91.4 ±35.3) min.The intraoperative blood loss was 78.8 ±34.1 ml. The resection of the prostate tissue weight was (32.1 ±15.7) g.The postoperative bladder infusion time was (1.5 ±0.5) days.The postoperative indwelling catheter time was 3.5 ±0.8 days.The postoperative hospital stay was (5.5 ±0.5) days.No death, blood transfusion, or TURS happened.Follow-up reviews at 3 months after surgery found postoperative international prostatic symptom score (IPSS) was significantly less than the preoperative level [4.5 ±2.2 vs.24.5 ±5.1, t=39.445, P=0.000], postoperative Qmax was significantly higher than preoperative level [(21.5 ±10.5) ml/s vs.(6.0 ±1.9) ml/s, t =15.912, P =0.000], and postoperative residual urine was significantly less than the preoperative level [(12.0 ±2.0) ml vs.(145.0 ±33.0) ml;t=44.069, P =0.000].No retrograde ejaculation, sexual dysfunction, or dysuria happened. Conclusion The four-step method for transurethral enucleation of the prostate is radical , safe, and simple.
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Objective To evaluate the therapeutic effect of ureteroscopy with holmium laser on ureteral stricture associated with calculi.Methods The clinical data of 36 cases of ureteral stricture associated with calculi undergoing ureteroscopy with holmium laser treatment were analyzed retrospectively with 26 cases of male patients and 10 cases of female patients.The age was 26-65 years.There were upper and middle ureteral stricture associated with calculi in 8 cases,and lower segment of ureteral stricture associated with calculi in 28 cases.All the patients were treated with ureteroscopy with holmium laser.All cases were followed up for 6-12 months.In the follow-up of 36 cases B ultrasound and urinary tract flat piece or intravenous urinary tract imaging were performed to evaluate the therapeutic effect.Results Thirty-six patients underwent ureteroscopy with holmium laser successfully.No conversion to open surgery occurred.Mean operating time was 30 (20-45) min.Mean hospital stay postoperatively was 3-5 d.Postoperative 8 cases with low thermal,alleviated by the anti-infection treatment,no ureteral avulsion,leakage and severe complications such as hemorrhage.Postoperative follow-up,32 cases (89％,32/36) were cured and 4 cases (11％,4/36) were improved.Conclusion Ureteroscopy with holmium laser in treatment of ureteral stricture associated with calculi is a simple and effective minimally invasive method.
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Objective To compare the clinical characters and hemodynamic data of the prone position and supine position percutaneous nephrolithotomy. Methods Patients with kidney stones in 100 cases were randomly assigned into the supine position group and prone position group.There were 50 cases in each group.The following data were recorded at preoperative,intraoperative,change position:the blood pressure,heart rate,respiration,saturation of blood oxygen and blood gas analysis results.The VAS score was recorded in patients for postural comfort,dyspnea and pain score. Results The systolic blood pressure in the preoperative,intraoperative,postoperative on supine position and prone position were as follows:(137±12),(119±15),(115±17) mm Hg and (137±10),(110±18),(104±16) mmHg.The diastalic blood pressure was as follows:( 81 ± 9 ),(74 ± 8 ),(63 ± 14 ) mm Hg and ( 84 ± 8 ),(63 ± 9 ),(60 ± 15) mm Hg.Compared with preoperative,there was a blood pressure decreased in both groups.The blood pH at preoperative,intraoperative,postoperative in supine position and prone position:7.4 ± 0,7.3 ± 0,7.3 ± 0 and 7.4 ± 0,7.3 ± 0,7.3 ± 0.The bass excess (BE) of two groups were:(2.1 ± 0.5),(-2.7 ±0.5),( -1.5 ±0.5) mmol/L and (3.2 ±0.5),(-3.8 ±0.5),(-2.5 ±0.5) mmol/L.Compared with preoperative data,the pH and BE declined in both groups.The prone position had more pronounced decrease in serum sodium,serum potassium; but with no significant difference.Supine group in postural comfort and breathing difficulties were 1.6 ± 0.4 and 7.1 4± 05,while prone group were 7.5 ± 0.2 and 1.4 ± 0.3.The supine position showed better in postural comfort and breathing difficulties with statistical significance. Conclusions Compared with the prone position,the supine positioned percutaneous nephrolithotomy could have less influence on hemodynamics,blood gas analysis.It could have better postural comfort.
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Objective To analyze the clinicopathologic characteristics and treatment of primary and secondary bladder mucosa lymphoma. Methods From June 1996 to September 2011,8 cases of bladder mucosa lymphoma patients including primary bladder mucosa lymphoma patients (2 males and 3 females)and secondary bladder mucosa lymphoma patients ( 1 male and 2 females) were treated in our institute.The patient's mean age was 68 years (ranged from 57 to 78 years),and the other 3 secondary bladder mucosa lymphoma patient's mean age was 61 years (ranged from 41 to 81 years).7 of 8 patients accepted transurethral resection of bladder tumor combined with CHOP chemotherapy and radiotherapy,and 1 patient abandoned treatment.CHOP chemotherapy and radiotherapy were performed at 2 weeks post-operatively.Secondary bladder mucosa lymphoma patients accepted 3-dimensional conformal 6000 cGy radiotherapy.Urinary CT examination showed that there were round or oval irregular tumors in the wall of urinary bladder,whose diameters were 1 to 4 cm.Tumor edges were glossy and tumor density were uniform.In addition,the bladder wall with tumor was uneven.In contrasted CT,the tumors appeared obviously enhanced.7 cases had cauliflower-like tumors found by cystoscope,and there were necrosis-calcification area in the center of tumors.1case appeared multiple tumors,which consisted of one big tumor and three smaller ones. Results There were 5 cases of primary bladder mucosa lymphoma, including 3 bladder mucosa associated lymphoma (MAL) cases and 2 diffuse large B cell lymphoma cases.There were 3 secondary bladder mucosa lymphoma cases including 2 diffuse large B cell lymphoma cases and 1 generalized follicular cystic central lymphoma case,which belongs to the tuberous sclerosis Hodgkin lymphoma.Immunohistochemical analysis showed that CD20,CD21,CD43 staining were positive in low grade MAL (3 cases).However,CD3,CD20,CD31 staining were positivein high grade MAL (5 cases). All patients were followed up 3 to 44 months.3 cases of secondary malignant lymphoma patients died after diagnosed after 3 to 13 months.5 cases of primary malignant lymphoma patients were all survived. 1 case recurred 14 months after surgery and accepted TURBT and CHOP chemotherapy again.Pathologic diagnosis showed the transformation from peripheral zone of bladder mucosa associated lymphoma to diffuse large B cell lymphoma.The patient was free of recurrence. Conclusions MAL and diffuse large B cell lymphoma are the most common type of bladder mucosa lymphoma.Primary and secondary diffuse large B cell lymphoma have similarities in histological analysis,but the former prognosis is better than the latter's. Transurethral resection of bladder tumor combined with chemotherapy and radiotherapy can prevent the relapse of MAL in short term and long term with good tolerance,and can be used as ideal treatment of MALT.
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Objective To explore the relationships between loneliness and sleep quality of undergraduates.Methods 751 undergraduates were investigated by UCLA Loneliness Scale and Pittsburgh Sleep Quality Index( PSQI).Results (1) No gender,grade and origin differences on loneliness were found,but non-only child undergraduates(43.09±7.22)felt lonely more than only-child undergraduates(41.37±8.38)(t=2.95,P=0.003).(2) No gender,grade and yes or no only child differences on the total score of PSQI were found,but undergraduates come from country (5.00±2.68)scored higher than those from city(4.59±2.79)(t＝2.019,P＜0.05).(3)Loneliness had significant positive correlations with the total score on the PSQI and the six components(except sleep duration)(r=0.12～0.27,P＜0.05～0.01).Lonely(5.72±3.25,1.20±0.93,1.09±0.70,0.23±0.64,1.64±0.93)and non-lonely undergraduates (4.63±2.56,0.99±0.79,0.96±0.53,0.08±0.37,1.39±0.85)differ significantly in total score of PSQI,sleep latency,sleep disturbance,sleep medication and daytime dysfunction(t=2.096～3.681,P＜0.05～0.001).Conclusion Loneliness of undergraduates maybe influence their sleep quality.