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Objective:To compare the safety and efficacy of 7.5 Fr and 9.5 Fr flexible ureteroscopy in the primary treatment of upper urinary tract calculi with maximum diameter<1.5 cm.Methods:Using a prospective randomized controlled study method, 96 patients with upper urinary tract calculi with maximum diameter<1.5 cm admitted to the Department of Urology, Beijing Friendship Hospital, Capital Medical University from August 2020 to May 2022 were selected as the study subjects. The patients were divided into two groups by random number table method: the experimental group and the control group, with 48 patients in each group. The experimental group patients underwent 7.5 Fr flexible ureteroscopic lithotripsy, while the control group patients underwent 9.5 Fr flexible ureteroscopic lithotripsy. Collect preoperative, intraoperative, and postoperative data from these patients, including success rate of ureteral access sheath insertion, surgical time, lithotripsy time, stone-free rate, ureteral injury status, and complications status. The measurement data were expressed as mean±standard deviation ( ± s), Student- t test was used for comparison between groups; the Chi-square test was used for inter-group comparison of count data, and the Mann-Whitney U test was used for inter-group comparison of rank data. Results:The success rate of primary sheath insertion in the experimental group was 93.8% (45/48), and that in the control group was 79.2% (38/48), the difference between the two groups was statistically significant ( P<0.05). There were no statistically significant difference between the experimental group and the control group in terms of surgical time [(52.0±11.0) min vs (55.1±11.4) min, P>0.05] and lithotripsy time [(26.0±9.3) min vs (23.7±8.7) min, P>0.05]. At four weeks after surgery, the stone-free rate in the experimental group was 93.3% (42/45), while that in the control group was 97.4% (37/38), there was no statistically significant difference between the two groups ( P>0.05). In terms of the degree of ureteral injury, there were 17 patients had grade 0 injury, 27 patients had grade 1 injury, 4 patients had grade 2 injury, and no patient had grade 3 injury in the experimental group; there were 9 patients had grade 0 injury, 23 patients had grade 1 injury, 13 patients had grade 2 injury, and 3 patients had grade 3 injury in the control group; the difference between the two groups was statistically significant ( P<0.05). In terms of complications, there were 22 cases of hematuria, 9 cases of pain, 8 cases of bladder spasm, and 2 cases of mild fever in the experimental group; there were 24 cases of hematuria, 12 cases of pain, 9 cases of bladder spasm, and 1 case of mild fever in the control group; there was no statistically significant difference between the two groups ( P>0.05). Conclusion:The application of 7.5 Fr flexible ureteroscopy and 9.5 Fr flexible ureteroscopy in the primary treatment of upper urinary tract calculi with maximum diameter<1.5 cm can achieve good stone-free rates, but the 7.5 Fr flexible ureteroscopy has a higher success rate of sheath insertion and less damage to the ureter.
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Objective:To evaluate the feasibility, safety and efficacy of the magnetic resonance imaging guided focused ultrasound surgery (MRgFUS) in the treatment of localized prostate cancer (PCa).Methods:The data of 5 patients treated by MRgFUS from August 2020 to June 2021 in our institution were retrospectively analyzed. The median age was 73 (58-80) years, with the median PSA of 7.34 (5.19-8.40) ng/ml, and a median prostate volume of 27.96 (21.50-37.91) ml. The median pretreatment international prostate symptom score (IPSS) was 13(0-18). Of the 3 patients with intention of erectile function preservation, the pretreatment international index of erectile function-15 (IIEF-15) score was 12, 23 and 3, respectively. All patients had histopathology-proven PCa of grade group ≤ International Society of Urological Pathology (ISUP) 3, pre-operative PSA level <20 ng/ml, and a clinical stage ≤T 2b. A total of 6 lesions was confirmed by biopsy, with 3 of ISUP grade group 3 and 3 of ISUP grade group 1. All 5 patients underwent MRgFUS which was guided by a real-time magnetic resonance imaging (MRI). PSA, MRI and repeated biopsy were conducted to monitor recurrence. Questionnaires consisted of IPSS, IIEF-15, and the International Consultation on Incontinence-questionnaire-Short Form (ICI-Q-SF) were recorded before and after MRgFUS to evaluate the impact on functional preservation. Results:A total of 5 patients received MRgFUS. In total, 5 of the 6 lesions were treated. 1 lesion unvisible on MRI was not clinically significant and was left untreated. The median time in MRI scanner was 190 (140-355) min, and the median sonication time was 64 (35-148) min with the median sonications of 8 (5-13). The median catheter indwelling time was 1 (1-8) days. No other adverse effects were reported. The PSA level of all 5 patients decreased, with the nadir PSA of 1.196 ng/ml, 4.398 ng/ml, 4.135 ng/ml, 1.562ng/ml and 1.350ng/ml, respectively. 4 of the patients had a PSA decrease over 50%. No PCa lesion was seen on MRI at 3-month follow-up visit. As for functional preservation, the post-MRgFUS IPSS declined compared with the baseline score, and the IPSS of last follow-up was 5(0-14). Of the 3 patients with intention to preserve the erectile function, the erectile function score of IIEF-15 were 12, 30 and 9 three months after the treatment, respectively. No incontinence occurred postoperatively.Conclusions:MRgFUS is a feasible and safe way for the treatment of low- to intermediate-risk localized PCa, with satisfactory performance on functional preservation and low incidence of complications. The oncological outcomes still need to be establised with longer follow-up time and larger sample studies.
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Objective:To evaluate the efficacy and safety of robotic arm assisted laparoscopic hysterosacral fixation in patients with pelvic organ prolapse(POP), and its impact on lower urinary tract function.Methods:This study retrospectively analyzed the clinical data of POP patients who had undergone robotic arm assisted laparoscopic hysterosacral fixation at our center from June 2019 to October 2020, and conducted exploratory research.Results:A total of 6 patients were included in the study, with POP quantitative staging above stage Ⅲ.The ages ranged from 70 to 82 years.The number of births each patient had given ranged from 1 to 3, & all were via vaginal deliveries.There were no significant changes in urodynamic parameter scores in any patients before and after surgery, but half of the patients had detrusor overactivity before surgery, which all disappeared after surgery.In addition, synchronous X-ray images showed that the postoperative pelvic organs were closer to the normal anatomical position.At the same time, quantitative staging of POP had achieved clear improvement, and related scale scores also significantly improved.One patient complained of occasional lumbar and back discomfort with postoperative over-stretching during outpatient review, which improved after symptomatic treatment.Conclusions:robotic arm assisted Laparoscopic hysterosacral fixation is satisfactory in efficacy and safety for POP patients, with good postoperative restoration of the uterus to the anatomical position and has insignificant influence on the function of the lower urinary tract.It is worth further assessment for wide application.
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Objective To analyze effects of androgen deprivation therapy on lipid metabolism and nutritional status in patients with prostate cancer.Methods The clinical data of 255 elderly patients (≥ 65 years old) with prostate cancer who received endocrine therapy and complete follow-up data from January 2010 to December 2018 were analyzed retrospectively.The median age of the 255 patients was 76 years (65-92).The average PSA of patients was (58.15 ± 9.62) ng/ml,where 101 patients had PSA ＜ 10 ng/ml,62 patients had PSA 10-20 ng/ml,and 92 patients had PSA ＞ 20 ng/ml.All patients were diagnosed pathologically by prostate biopsy.As for Gleason score,Gleason score≤6,Gleason score =7 and Gleason score ≥ 8 had 62,103 and 90 patients,respectively.Endocrine therapy included maximum androgen blockade (197 cases) and drug castration (58 cases),and continued for at least 1 year.Among them,123 cases had complete blood lipid index data,and the subgroup analysis was based on the age of 80 years old,including 98 cases aged 65 to 80 years old and 25 cases over 80 years old.A total of 186 cases had complete data of total protein and albumin,of which 147 cases were 65 years old and 80 years old and 39 cases were more than 80 years old.Before treatment,cholesterol was (4.08 ±0.87) mmoL/L,including (4.14 ±0.86) mmol/L in the 65-80 years old group,(3.82 ± 0.88) mmol/L in ＞ 80 years old group;triglyceride was (1.23 ± 0.56) mmol/L,65-80 age group was (1.26 ± 0.56) mmol/L and ＞ 80 years old group was (1.11 ± 0.57) mmol/L;High density lipoprotein cholesterol was(1.09 ± 0.24)mmol/L,65-80 age group was (1.10 ±0.25) mmol/L and ＞ 80 years group was (1.04 ± 0.21) mmol/L.Low density lipoprotein cholesterol was (2.50 ± 0.78) mmol/L,65 ～ 80 age group was (2.55 ± 0.77) mmol/L and (2.34 ± 0.83) mmol/L in ＞80 years old group.The total protein before endocrine therapy was (63.81 ± 5.93) g/L,including (63.95 ± 5.79) g/L in the 65-80 years old group,(63.30 ± 6.49) g/L in ＞ 80 years old group.In terms of pre-treatment albumin (39.68 ± 3.50) g/L,including (39.82 ± 3.60) g/L in the 65-80 years old group and (39.21 ± 3.12) g/L in ＞ 80 years old group.The differences of various indexes before and after treatment were analyzed.Results The results of blood lipid data analysis of 123 cases showed that,there were increased significant differences(P ＜ 0.01) in cholesterol (4.80 ± 1.82)mmol/L,triglyceride (1.59 ± 1.17) mmol/L,high density lipoprotein cholesterol (1.21 ± 0.25) mmol/L and low density lipoprotein cholesterol (3.07 ± 1.53) mmol/L after endocrine therapy compared with baseline.In the subgroup analysis,the levels of cholesterol,triglyceride,high density lipoprotein cholesterol and low density lipoprotein cholesterol in 65-80-year-old group after treatment were (4.92 ± 1.95) mmol/L,(1.64 ± 1.25) mmol/L,(1.20 ± 0.25) mmol/L,and (3.15 ± 1.66) mmol/L,respectively,which were significantly higher than those before treatment (P ＜0.01).In the group over 80 years old,the blood lipid index after treatment was higher than that before treatment,including cholesterol (4.35 ± 1.08) mmol/L,triglyceride (1.39 ± 0.73) mmoL/L,high density lipoprotein cholesterol (1.27 ± 0.26) mmol/L and low density lipoprotein cholesterol (2.76 ± 0.93) mmol/L.The levels of cholesterol,triglyceride and high density lipoprotein cholesterol were significantly higher than those before treatment (P ＜ 0.05),but there was no significant difference in low density lipoprotein cholesterol between before and after treatment (P ＞ 0.05).The results of data analysis of 186 cases of total protein and albumin showed that,the total protein after treatment was (62.81 ±7.34) g/L,which was not significantly different from that before treatment (P ＞ 0.05).The total protein in 65-80 years old group after treatment was (62.36 ± 7.36) g/L,which decrease and have statistical significantly different from that before treatment (P ＜ 0.05);The total protein in ＞ 80 years old group after treatment was (64.49 ± 7.12) g/L,it was higher than that before treatment,but the difference was not statistically significant (P ＞ 0.05).The level of albumin after endocrine therapy was (38.34 ± 4.48) g/L,which was significantly different from that before treatment (P ＜ 0.01).The levels of albumin in 65-85 years old group and ＞ 80 years old group after treatment were (38.32 ± 4.54) g/L and (38.44 ± 4.30) g/L respectively,but only in the group of 65 to 80 years old,there were significant differences compared with those before treatment (P ＜ 0.05).Conclusion Endocrine therapy can not only significantly increase total cholesterol,triglyceride,low density lipoprotein cholesterol and high density lipoprotein cholesterol in elderly patients with prostate cancer,but also significantly reduce albumin after treatment.
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Objective:To investigate the effect of maximal androgen blockade(MAB)therapy on serum calcium, phosphorus and other metabolic indices in elderly patients with prostate cancer.Methods:Clinicopathological data of prostate cancer patients treated with MAB in our department from January 2010 to December 2018 were retrospectively analyzed.All patients underwent prostate biopsy for definitive diagnosis.Detailed data on patient's age, body mass index(BMI), previous medical history, treatment plan and peripheral blood indicators before and after endocrine treatment, such as blood calcium, phosphorus, hemoglobin, fasting blood glucose, triglycerides and cholesterol, were collected.Results:Patients had a mean age of(75.5±5.8)years and a mean BMI of(24.6±3.2)kg/m 2.Blood calcium levels exhibited a downward trend after MAB treatment compared pre-treatment[(2.12±0.44)mmol/L vs.(2.17±0.31)mmol/L, t=0.82, P=0.42], but had no significant difference.Serum phosphorus concentrations were higher and the calcium-phosphorus ratio was lower after MAB treatment than before treatment[(1.02±0.26)mmol/L vs.(1.17±0.34)mmol/L, 2.10±0.28 vs.1.88±0.60, t=-4.12 and 3.56, P<0.01]. After MAB treatment, blood fasting glucose[(6.50±1.55)mmol/L vs.(5.34±1.04)mmol/L, t=-7.82, P<0.01], triglycerides[(1.66±1.32)mmol/L vs.(1.22±0.59)mmol/L, t=-3.38, P<0.01]and cholesterol[(4.70±1.08)mmol/L vs.(4.16±0.90)mmol/L, t=-4.72, P<0.01]were elevated, while hemoglobin concentrations[(122.11±20.43)g/L vs.(130.78±23.98)g/L, t=3.98, P<0.01]were decreased compared with pre-treatment levels. Conclusions:MAB therapy can cause varying degrees of metabolic abnormalities in calcium and phosphorus metabolism, hemoglobin concentrations, blood glucose and lipid levels in elderly prostate cancer patients.The above indicators should be closely monitored during treatment, and treatment-related complications should be proactively prevented.