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Prostate cancer is a common malignant tumor in male genitourinary system, and radical prostatectomy is one of the important methods to treat prostate cancer. Indocyanine green is a non-radioactive, water-soluble compound, which can help identify anatomical structures and visualize blood vessels through near-infrared fluorescence. The role and injection techniques of Indocyanine green in radical prostatectomy in sentinel lymph node identification, pelvic lymph node dissection and neurovascular bundle preservation are reviewed, so as to provide a reference for improving the surgical effect, reducing the difficulty of surgery, and prolonging the survival period of patients, and evaluate the potential research field of this technology in the future.
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Cystitis glandularis is a hyperplastic disease originated from the bladder mucosa, cystitis glandularis is a rare clinical disease, there is no standard diagnosis and treatment. The etiology and pathogenesis of cystitis glandularis are still unknown, it can be diagnosed according to clinical manifestations, laboratory and auxiliary examinations, and the diagnosis of cystitis glandularis mainly depends on pathological results. Cystitis glandularis has a cancerous tendency. The clinical treatment methods of cystitis glandularis include conservative treatment, surgical treatment and surgical combined with drug therapy, but different types of treatment methods are different, and most patients are treated by surgery combined with drug perfusion of the bladder.This article will review the research progress in diagnosis and treatment of cystitis glandularis.
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Objective:To investigate the effectiveness of enhanced recovery after surgery (ERAS) concept in perioperative period of retroperitoneal laparoscopic radical nephrectomy.Methods:The clinical data of 189 patients who underwent retroperitoneal laparoscopic radical nephrectomy from October 2015 to July 2021 were retrospectively analyzed. According to different perioperative management methods, they were divided into two groups: ERAS group ( n=97) and traditional group ( n=92). Patients of ERAS group were managed by the ERAS concept during the perioperative period, patients of traditional group were managed by the traditional method during the perioperative period. First drinking time after surgery, first exhaust time, 24 h postoperative pain score, first activity time out of bed, indwelling time of urinary catheter, indwelling time of drainage tube, postoperative hospital stay, incision length and complications of pneumonia and venous thrombosis were recorded and compared between the two groups. Measurement data were expressed as mean ± standard deviation ( Mean± SD), and independent sample t-test was used for comparison between groups; count data comparison between groups was by Chi-square test or Fisher exact probability method. Results:There were no significant differences in age, gender, body mass index, tumor side, tumor diameter, maximum diameter of samples, T stage, diabetes and hypertension from between two groups ( P >0.05). In ERAS group, the time of first drinking water after surgery was (3.8±1.4) h, the time of first anal exhaust was (10.2±2.5) h, the 24 h pain score was (2.4±1.0), the time of first activity out of bed after surgery was (18.8±3.6) h, the indwelling time of urinary catheter was (19.8±3.7) h, the indwelling time of drainage tube was (3.4±0.5) d, the surgical incision length was (7.2±0.9) cm, and the postoperative hospital stay was (5.5±0.6) d. In the traditional group, the time of first drinking water after surgery was (21.2±4.2) h, the time of first anal exhaust was (20.1±4.3) h, the 24 h pain score was (5.4±1.0), the time of first activity out of bed after surgery was (32.8±7.8) h, the indwelling time of urinary catheter was (55.7±8.0) h, the indwelling time of drainage tube was (4.2±0.5) d, the surgical incision length was (13.6±1.5) cm, and the postoperative hospital stay was (7.2±1.3) d. There were statistically significant differences in these indexes between the two groups ( P<0.05). Conclusion:The clinical application of the concept of ERAS during the perioperative period can promote the rapid postoperative recovery of patients undergoing retroperitoneal laparoscopic radical nephrectomy, and can effectively reflect the minimally invase advantages of retroperitoneal laparoscopic technology.
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Gleason grading system is a critical factor for assessing the risk, making treatment decision and evaluating prognosis for patients with prostate cancer. However, it has been reported that concordance rates of Gleason score between biopsy pathology and radical prostatectomy specimen were only39%-63%, whilst postsurgical upgrade and downgrade rates were 30%-55% and 7%-20% respectively. This situation brings difficulties in performing clinical practice. This literature aimed to review relevant and updated studies in literature to summarize the concordance rate and independent predictive factors of Gleason score change from following several aspects: patient clinical characteristics, biopsy-related factors, accuracy of pathologic assignment and interpretation of pathology reports. This review also investigated how the factors influenced the Gleason score change and clinical decision-making. There were many factors influencing the Gleason score change which were roughly consistent with risk factors of prostate cancer, however, some factors were controversial. In order to provide precise evaluation of risk stratification and optimal individualized treatment, it is essential to consider the risk factors which are correlated with Gleason score change.
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Objective:To analyze the risk factors of stress urinary incontinence after transurethral enucleation of prostate.Methods:A retrospective analysis of the clinical data of 326 patients who underwent transurethral enucleation of prostate at the Beijing Friendship Hospital, Capital Medical University due to benign prostatic hyperplasia from March 2016 to December 2019. Patients were divided into stress urinary incontinence group ( n=78) and non-stress urinary incontinence group ( n=248) according to whether there was stress urinary incontinence one week after the catheter was removed. Age, body mass index, hypertension, diabetes, hyperlipidemia, prostate volume, the time of lower urinary tract symptoms (LUTS), total prostate specific antigen, preoperative indwelling catheter status, operation type, operation time, percentage of hemoglobin reduction and catherization time were compared between the two groups. Measurement data were expressed as mean±standard deviation ( Mean± SD), and t-test was used for comparison between groups; Chi-square test or Fisher exact probability method was used for comparison of count data between groups. Single factor and multivariate Logistic regression analysis were used to screen independent predictors. Results:Age [(73.9±7.3) years vs (69.5±7.8) years, P<0.001], body mass index [(25.6±3.0) kg/m 2vs (24.6±2.9) kg/m 2, P=0.004], the time of LUTS [(5.42±5.65) years vs (5.05±5.19) years, P=0.008], and hypertension (57.7% vs 43.6%, P=0.037), prostate volume [(77.1±33.2) mL vs (62.5±30.2) mL, P<0.001], operation time [(115.0±45.7) min vs (99.8±41.4) min, P=0.006] in stress urinary incontinence group were significantly higher than those in the non-stress urinary incontinence group, the differences were statistically significant. Age ( OR=1.05, 95% CI: 1.02-1.07, P<0.001), body mass index ( OR=1.08, 95% CI: 1.03-1.14, P=0.003), LUTS ( OR=1.21, 95% CI: 1.14-1.29, P=0.015)and prostate volume ( OR=1.11, 95% CI: 1.10-1.11, P=0.011) were independent risk factors for stress urinary incontinence after transurethral enucleation of prostate by multivariate Logistic regression analysis. Conclusion:Age≥70years, body mass index≥25 kg/m 2, LUTS during≥5 years and prostate volume≥75 mL are independent risk factors for stress urinary incontinence after transurethral enucleation of prostate.
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Objective To investigate the clinical features of chromophobe renal cell carcinoma (chRCC) and analyze the factors affecting its prognosis.Methods Retrospectively analyze the case data of 66 patients with chRCC admitted to Beijing Friendship Hospital,Capital Medical University from October 2003 to September 2018,including 32 males and 34 females;the average age was (53.9 ± 13.9) years and the age range was 24-85 years.To analyze the clinical symptoms,whether have hypertension,diabetes,tumor characteristics (size,side,location),surgical methods,TNM staging and other clinical features of patients,with disease-free survival (DFS)as the study endpoint.The survival curve was drawed by the kaplan-Meier method.Survival analysis was performed using Log-rank test,and the clinical features of prognosis were analyzed by Cox regression models.Results Among the 66 patients,the mean diameter of the tumor was (5.4 ±3.5) cm,17 cases were ≥7 cm,49 cases were ＜7 cm;48 cases were asymptomatic,and 18 cases were symptomatic;45 cases in T1,15 cases in T2,6 cases in T3;33 cases were underwent radical nephrectomy,32 cases were underwent nephron sparing surgery,1 case was under the therapy of watchful waiting.The median follow-up time was 61 months,and the DFS in 1,5,and 10 years were 94.6％,91.3％,and 82.2％,respectively.Log-rank results showed that the maximum diameter of the tumor was related to the T stage and the survival time of the patients (P ＜ 0.05).Cox multivariate analysis showed that T stage was an independent risk factor for DFS (HR =8.102,P =0.027).Conclusions ChRCC is a type of kidney cancer with a good prognosis.Tumor staging is more common in T1 and T2 phases,patients with higher DFS in 5and 10 years,and T staging is an independent risk factor for DFS in patients.
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Objective@#To investigate the clinical features of chromophobe renal cell carcinoma (chRCC) and analyze the factors affecting its prognosis.@*Methods@#Retrospectively analyze the case data of 66 patients with chRCC admitted to Beijing Friendship Hospital, Capital Medical University from October 2003 to September 2018, including 32 males and 34 females; the average age was (53.9±13.9) years and the age range was 24-85 years. To analyze the clinical symptoms, whether have hypertension, diabetes, tumor characteristics (size, side, location), surgical methods, TNM staging and other clinical features of patients, with disease-free survival (DFS) as the study endpoint. The survival curve was drawed by the kaplan-Meier method. Survival analysis was performed using Log-rank test, and the clinical features of prognosis were analyzed by Cox regression models.@*Results@#Among the 66 patients, the mean diameter of the tumor was (5.4±3.5) cm, 17 cases were ≥7 cm, 49 cases were <7 cm; 48 cases were asymptomatic, and 18 cases were symptomatic; 45 cases in T1, 15 cases in T2, 6 cases in T3; 33 cases were underwent radical nephrectomy, 32 cases were underwent nephron sparing surgery, 1 case was under the therapy of watchful waiting. The median follow-up time was 61 months, and the DFS in 1, 5, and 10 years were 94.6%, 91.3%, and 82.2%, respectively. Log-rank results showed that the maximum diameter of the tumor was related to the T stage and the survival time of the patients (P<0.05). Cox multivariate analysis showed that T stage was an independent risk factor for DFS (HR=8.102, P=0.027).@*Conclusions@#ChRCC is a type of kidney cancer with a good prognosis. Tumor staging is more common in T1 and T2 phases, patients with higher DFS in 5 and 10 years, and T staging is an independent risk factor for DFS in patients.
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Objective To investigate the prognostic factors of renal cell carcinoma and to establish a prognostic model for patients with non-metastasis renal cell carcinoma (RCC) after operation.Methods We retrospectively reviewed the clinical data of patients with RCC who underwent radical or partial nephrectomy from January 2008 to December 2012,including 392 males (67.6％) and 188 females (32.4％),with an average age of 56 years(range 24-86 years).The average diameter of tumor was 4.8 cm (range 1.5-17.5 cm).The pathological slides of tumor tissue were reviewed by pathologist,and the tissue microarray (TMA) were constructed.The immunohistochemical staining of TMA were carried out.All patients were followed up the prognosis information of the overall survival (OS),cancer specific survival (CSS) and progression free survival (PFS).Based on these data,univariate and multivariate analysis and survival analysis were performed.Independent prognostic factors related to different follow-up endpoints of patients were screened out.A Nomogram prognostic model for RCC was established and verified.Internal validation were performed by boots value analysis.Results Among 580 cases,160 cases (27.6％) accepted nephron sparing surgery and 420 cases (72.4％) radical nephrectomy,included 514 cases (88.6％) of laparoscopic surgery and 66 cases (11.4％) of open surgery.There were 468 cases of clear cell carcinoma (80.7％),56 cases of papillary carcinoma (9.7％),32 cases of chromophobe cell carcinoma (5.5％),24 patients with other subtypes of cancer cells (4.1％).In pathological staging,stage Ⅰ,Ⅱ,Ⅲ,Ⅳ were 442 cases (76.2％),88 cases (15.2％),48 cases (8.3％),2 cases (0.3％),respectively.There were 424 cases (73.1％) with high expression of CA9,and 156 cases (26.9％) with low expression.The median followup was 66 (4-82) months,and 41 cases (7.1％) were lost of follow-up.For 3 and 5 years,OS,CSS and PFS were 83.4％,88.2％,72.4％ and 69.6％,73.0％,55.8％ respectively.Multivariate analysis showed that tumor pathological subtypes,tumor stage,tumor diameter and positive expression of carbonic anhydrase 9 (CA9) were independent prognostic factors associated with the survival of RCC patients.The Nomogram prognostic model was established by the above four factors.The established Nomogram prognostic model for RCC patients was verified by Harrell's consistency index,and the c-index of OS,CSS and PFS of RCC patients were 0.72 (95％ CI 0.69-0.75),0.77 (95％ CI 0.74-0.81),0.79 (95％ CI 0.76-0.83),respectively.Conclusions Tumor pathological subtypes,staging,tumor diameter and CA9 are independent risk factors for patients with non metastatic renal cell carcinoma.The established Nomogram prognostic model certified by internal validation should be tested by large samples and multicenter studies need tested.
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Objective To investigate the efficacy of microsurgical subinguinal varicocelectomy for unilateral varicocele.Methods One hundred and five cases with left side varicocele were enrolled from August 2012 to October 2016.Thirty one cases suffered from varicocele in Ⅱ degree,and other seventy four cases in Ⅲ degree.Clinical data including operation time,sperm quality,testosterone level,complications and natural pregnoncy rate were retrospectively analyzed.The measurement data were expressed by (x) ± s.Sperm concentration,sperm motility,the rate of sperm normal morphology and serum testosterone levels were compared before and after operation with paired t test.Results The average operative time of varieocele was (58 ± 9) minutes in the outer ring of the microscope.Compared with preoperation's,sperm concentration,sperm motility,the rate of sperm normal morphology was remarkable improved after 3 month.However,serum testosterone levels were steady.In the outpatient follow-up,there were no complications,such as orchiatrophy,hydrocele of tunica vaginalis or recurrence of varicocele.The rate of natural pregnoncy in one year was 46.7％.Conclusions Microsurgical subinguinal varicocelectomy can remarkably improve sperm quality for patients,who suffer from varicocele in Ⅱ or Ⅲ degree.The complication of microsurgical subinguinal varicocelectomy is rare.Male infertility patients resulted from varicocele will get favorable natural pregnoncy rate.
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Objective To investigate the efficacy of percutaneous renal access with balloon dilation for staghorn calculi.Methods Eighty-nine cases with PCNL were enrolled from February 2012 to March 2015.Clinical data including the time for setting the renal access, operation time, residual stone rate, complications were analyzed.Results Eighty-nine cases established nephrostomy tracts successfully.The average time for setting the renal access was (5.7 ± 1.0) min (4-8 min).The average of operation time was (62.6 ± 14.1) min (37-87min).The average of Hemoglobin decline rate was (6.3 ± 2.5)％ (2.8％-16.9％).The residual stone rate was 12.5％.Conclusions PCNL with ballon dilation is a fast, safe and effective means for staghorn calculi.It is worth using for staghorn calculi.
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Objective To improve the understanding of bacteria bolt in upper urinary tract,and to investigate its diagnosis and treatment.Methods The clinical data of 11 cases with bacteria bolt in upper urinary tract were reviewed retrospectively.The clinical manifestation and treatment were summarized.Results Infection and obstruction were the clinical manifestation.Two-stage treatment was provided.Ureteral stent was indwelled in two cases,and percutaneous nephrostomy was provided at the first stage in the other 9 cases.Then the bacteria bolt was taken by ureteroscopy (1 case) or by percutaneous nephrostomy (10 cases) when the condition improved.The second stage operation took 37 min on average (ranged from 20 to 55).Estimated blood loss 60 ml on average (ranged from 10 to 200 ml).Hemoglobin decreased 5.1 g/L (3-11 g/L) 48 hours after operation in the 10 cases underwent percutaneous nephrostomy.Bolt-free rate was 100％.There was no infectious shock occurred.No relapse was observed during the 16 months of follow-up.Conclusions Bacteria bolt in upper urinary tract is not common.Infection and obstruction are its manifestation.Two-stage treatment is safe and effective.