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Metastatic castration-resistant prostate cancer (mCRPC) is the inevitable form of most prostate cancers after endocrine therapy, and conventional drugs are not effective at this time.In this case, an elderly mCRPC patient with cardiopulmonary diseases admitted to the First Hospital of Shanxi Medical University in August 2020 was selected. After the failure of traditional endocrine therapy, enzalumide+ ADT regimen was adopted, and the patient's blood PSA was significantly reduced without cardiopulmonary adverse events.
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Objective@#To assess the clinical effects of percutaneous electrical stimulation on refractory lower urinary tract symptoms in elderly female patients.@*Methods@#Elderly female patients with refractory lower urinary tract symptoms from July 2016 to December 2017 were recruited.According to cystoscopy results, patients were divided into an interstitial cystitis group, a suspected interstitial cystitis group and an overactive bladder group.All patients received 3 courses of transcutaneous low-frequency electrical stimulation treatment in the suprapubic bladder area, with 40 min per time, 4 times per day, 7 days per course.Bladder diaries, pain scores and overactive bladder symptom scores were recorded before and after treatment.@*Results@#A total of 27 patients with a mean age of 74.3 years were enrolled.Under the cystoscope with water dilatation, 9 cases were found to have mucosal bleeding, with mast cells detected in mucosal specimens examined via electron microscopy(in the interstitial cystitis group), 5 cases had superficial mucosal congestion(in the suspected interstitial cystitis group)and 13 cases showed normal imaging(in the overactive bladder group). In the interstitial cystitis group, the 24-h urinary frequency improved from 15.4±2.5 times before treatment to 11.9±2.0 times after treatment(P<0.05), but pain scores had no significant difference before and after treatment[(8.3±2.0) and (8.2±1.6), P>0.05]. In the suspected interstitial cystitis group, the 24-h urinary frequency improved from (11.8±1.5) times before treatment to (8.4±1.1) times after treatment, and pain scores decreased from (6.4±1.1) to (4.2±1.1)(P<0.05). In the overactive bladder group, the 24-h urinary frequency improved from (19.2±2.0) times before treatment to (15.9±1.3) times after treatment(P<0.05), and the overactive bladder symptom score(OABSS)decreased from (8.9±1.6) to (5.9±1.6)(P<0.05).@*Conclusions@#Percutaneous electrical stimulation is an easy, safe and effective treatment in elderly females with refractory lower urinary tract symptoms, and should be encouraged in clinical practice.
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Objective@#To explore the clinical feasibility and effectiveness of novel preoperative evaluating tool to achieve accurate and quantitative evaluation of renal vascular anatomy for retroperitoneoscopic radical nephrectomy (RLRN).@*Methods@#Two-hundred and fifty one consecutive patients who underwent RLRN for renal tumours from September 2016 to March 2018 were enrolled prospectively, including 154 males (61.4%) and 97 females (38.6%), aged 26 to 84 years with the mean age of 58.7 and mean BMI of 25.8 kg/m2. The tumors were all isolated with the mean size of 5.4 cm. According to presence or absence of vascular correlation events (VCE) and nephrectomy times under endoscope (NTE), all the cases were divided into two groups: the common group (VCE, NTE <60 min) and the difficult group (no VCE, NTE ≥60 min). With the help of preoperative three-dimensional reconstruction, the specific and crucial arteriovenous anatomical features were recorded, which consist of side, count, spatial configuration and density of the vessel to be processed. After univariable analysis, multivariable analysis with logistic regression was performed for the selected risk factors. Individualized reno-vasculature evaluation for nephrectomy were established, when the value of risk factors were assigned separately according to its correlation and clinical practice.@*Results@#There was no statistical significance between common group and difficult group in the aspects of gender, age, BMI, maximum diameter of the tumor, R. E.N.A.L. score and PADUA score. There were statistical significance between common group and difficult group in the aspects of N (number of total vessels), D (vascular anomalies density), C (3D conformation), S (sides) of pending renal vessels (χ2=125.700, 102.014, 97.090, 12.603, P<0.05). The correlation of N, D, C were closely related (standardized regression coefficient were 0.742, 0.664, 0.324, P<0.05), but S was not significant (P>0.05). SIREN was preliminarily established as a preoperative evaluating tool to achieve accurate and quantitative evaluation of renal vascular anatomy. Of the 5 components of SIREN, N, D were scored on 1 to 3 points, C was scored on 0 to 3 points, E was scored on 0 to 1 point, and S was not scored but showed in terms of L or R. All of these constitute the assessment content with a full score of 10 points except S suffixed by L or R instead of scores. There was a statistically significant difference during low (2-3 points), middle (4-6 points), and high (7-10 points) groups (χ2=126.927, P<0.05) according to the comparisons between low and middle, low and high, as well as middle and high (χ2=90.997, 7.195, 91.679, P<0.05).@*Conclusions@#In virtue of the renal vascular scoring system named after SIREN by 3d reconstructing, the spatial structure information of the renal vascular system can be obtained accurately and expressed directly before operation, the difficulty of vascular treatment can be predicted, the preoperative planning can be optimized, and the accurate quantitative evaluation of renal vascular anatomical structure can be achieved to further improve the surgical safety and efficiency.
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Objective To explore the clinical feasibility and effectiveness of novel preoperative evaluating tool to achieve accurate and quantitative evaluation of renal vascular anatomy for retroperitoneoscopic radical nephrectomy (RLRN).Methods Two-hundred and fifty one consecutive patients who underwent RLRN for renal tumours from September 2016 to March 2018 were enrolled prospectively,including 154 males (61.4％) and 97 females (38.6％),aged 26 to 84 years with the mean age of 58.7 and mean BMI of 25.8 kg/m2.The tumors were all isolated with the mean size of 5.4 cm.According to presence or absence of vascular correlation events (VCE) and nephrectomy times under endoscope (NTE),all the cases were divided into two groups:the common group (VCE,NTE ＜ 60 min)and the difficult group (no VCE,NTE ≥ 60 min).With the help of preoperative three-dimensional reconstruction,the specific and crucial arteriovenous anatomical features were recorded,which consist of side,count,spatial configuration and density of the vessel to be processed.After univariable analysis,muhivariable analysis with logistic regression was performed for the selected risk factors.Individualized renovasculature evaluation for nephrectomy were established,when the value of risk factors were assigned separately according to its correlation and clinical practice.Results There was no statistical significance between common group and difficult group in the aspects of gender,age,BMI,maximum diameter of the tumor,R.E.N.A.L.score and PADUA score.There were statistical significance between common group and difficult group in the aspects of N (number of total vessels),D (vascular anomalies density),C (3Dconformation),S (sides) of pending renal vessels (x2 =125.700,102.014,97.090,12.603,P ＜0.05).The correlation of N,D,C were closely related (standardized regression coefficient were 0.742,0.664,0.324,P ＜ 0.05),but S was not significant (P ＞ 0.05).SIREN was preliminarily established as a preoperative evaluating tool to achieve accurate and quantitative evaluation of renal vascular anatomy.Of the 5 components of SIREN,N,D were scored on 1 to 3 points,C was scored on 0 to 3 points,E was scored on 0 to 1 point,and S was not scored but showed in terms of L or R.All of these constitute the assessment content with a full score of 10 points except S suffixed by L or R instead of scores.There was a statistically significant difference during low (2-3 points),middle (4-6 points),and high (7-10 points) groups (x2 =126.927,P ＜ 0.05) according to the comparisons between low and middle,low and high,as well as middle and high (x2 =90.997,7.195,91.679,P ＜ 0.05).Conclusions In virtue of the renal vascular scoring system named after SIREN by 3d reconstructing,the spatial structure information of the renal vascular system can be obtained accurately and expressed directly before operation,the difficulty of vascular treatment can be predicted,the preoperative planning can be optimized,and the accurate quantitative evaluation of renal vascular anatomical structure can be achieved to further improve the surgical safety and efficiency.
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Objective To assess the clinical effects of percutaneous electrical stimulation on refractory lower urinary tract symptoms in elderly female patients.Methods Elderly female patients with refractory lower urinary tract symptoms from July 2016 to December 2017 were recruited.According to cystoscopy results,patients were divided into an interstitial cystitis group,a suspected interstitial cystitis group and an overactive bladder group.All patients received 3 courses of transcutaneous low-frequency electrical stimulation treatment in the suprapubic bladder area,with 40 min per time,4 times per day,7 days per course.Bladder diaries,pain scores and overactive bladder symptom scores were recorded before and after treatment.Results A total of 27 patients with a mean age of 74.3 years were enrolled.Under the cystoscope with water dilatation,9 cases were found to have mucosal bleeding,with mast cells detected in mucosal specimens examined via electron microscopy(in the interstitial cystitis group),5 cases had superficial mucosal congestion (in the suspected interstitial cystitis group)and 13 cases showed normal imaging(in the overactive bladder group).In the interstitial cystitis group,the 24-h urinary frequency improved from 15.4 ± 2.5 times before treatment to 11.9 ± 2.0 times after treatment (P ＜0.05),but pain scores had no significant difference before and after treatment[(8.3±2.0) and (8.2±1.6),P＞0.05].In the suspected interstitial cystitis group,the 24-h urinary frequency improved from (11.8 ± 1.5) times before treatment to (8.4±1.1) times after treatment,and pain scores decreased from (6.4±1.1) to (4.2±1.1) (P＜0.05).In the overactive bladder group,the 24-h urinary frequency improved from (19.2±2.0) times before treatment to (15.9 ± 1.3) times after treatment(P ＜0.05),and the overactive bladder symptom score(OABSS)decreased from (8.9±1.6) to (5.9±1.6)(P＜0.05).Conclusions Percutaneous electrical stimulation is an easy,safe and effective treatment in elderly females with refractory lower urinary tract symptoms,and should be encouraged in clinical practice.
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Objective To compare the safety, efficacy, intraoperative and postoperative outcomes between retro-laparoscopic partial nephrectomy with robotic-assisted laparoscopic (RA-RLPN) and three-dimensional laparoscopic systems(3D-RLPN).Methods Between May 2017 and November 2017,53 patients with cT1-staged renal mass underwent RLPN with two different systems in the First Hospital of Shanxi Medical University. Twenty-eight patients underwent RA-RLPN and twenty-five patients underwent 3D-RLPN. The safety, efficacy, intraoperative and postoperative outcomes were retrospectively analyzed between the two groups. Results All the operations were technically successful. Mean operating room time [(82±18) min vs. (105±5)min,t=4.958,P <0.001)],mean renal artery clamping time[(14.6±2.9)min vs. (18.4±3.5) min,t =5.616, P < 0.001] and postoperative hospitalization [(6.6±1.4) d vs. (7.2±1.5) d, t=2.647, P = 0.021] in RA-RLPN group were shorter than those in 3D-RLPN group. The estimated blood loss was reduced in RA-RLPN group compared with 3D-RLPN group [(60±20) ml vs. (76±24) ml, t= 2.958, P = 0.012]. The postoperative hospital stay in RA-RLPN group was shorter than that in 3D-RLPN group[(6.6±1.4) d vs. (7.2± 1.5) d, t= 2.647, P = 0.021)]. There were no significant differences in the postoperative complications and positive pathological margin incidence between the two groups(both P >0.05).Conclusions RA-RLPN, as a promising surgical technique, is a feasible and safe procedure associated with better intraoperative parameters and short-term effect.It is worthy of clinical application.
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Objective To explore the feasibilities and clinical applications for sharing the medical resources and recycles by applying digital medicine technology and making the most of medical CT films from other hospitals.Methods Based on scanning data of medical CT films from other hospitals,which were in 85 cases of undergo retroperitoneal laparoscopic surgery,the 3D models were reconstructed in the computer,then were verified and navigated during operations.Meanwhile,coincidence rates were compaired between group A (slice thickness =5 mm) and group B (slice thickness ＞5 mm) in 53 cases whose renal pedicle blood vessels were exposed during the operations.Results All the 85 procedures were successfully completed.The 3D models,which could be observed freely,were consistent with intraoperative screenshots and participated in intraoperative guidance.Coincidence rates were 82.4％ (28/34) in group A and 52.6％(10/19) in group B (x2 =5.306,P =0.021).Conclusions Based on medical CT films of 5 mm slice thickness,the 3D models which are verified to have some accuration and fineness can be successfully reconstructed.The method not only can effectively avoid unnecessary repeated inspection,but also directly render in 3D form to participate in preoperative planning and intraoperative guidance.