Photoselective Vaporesection of the Prostate with an End-firing Lithium Triborate Crystal Laser / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Photoselective vaporization of the prostate is a technique that is widely used for the treatment of benign prostatic hyperplasia (BPH) and has pronounced advantages compared to the traditional transurethral resection of the prostate. Following the recent introduction of end-firing lithium triborate lasers, we have created a new technique called photoselective vaporesection of the prostate (PVRP). This study described our initial experience using the PVRP technique for the treatment of BPH.</p><p><b>METHODS</b>This prospective study included a total of 35 patients with BPH who underwent PVRP from August 2013 to July 2014. The chief clinical parameters were obtained and evaluated during the perioperative period and follow-up, including the International Prostate Symptom Score (IPSS), quality of life (QoL) score, maximum urinary flow rate, and prostate volume. All variables were evaluated for statistically significant differences compared to baseline values using the analysis of variance.</p><p><b>RESULTS</b>The mean subgroup IPSS and QoL scores significantly improved during follow-up; the respective decreases in IPSS storage score, IPSS voiding score, IPSS nocturia score, and QoL score were 75.3%, 83.6%, 51.4%, and 71.7%, respectively (all P < 0.001 compared with baseline). Three patients were diagnosed with prostate cancer based on postoperative pathological examinations. There were no serious perioperative complications.</p><p><b>CONCLUSION</b>The PVRP technique demonstrates satisfactory short-term clinical outcomes and perioperative safety in the treatment of BPH.</p>

Study on patients with benign prostate hyperplasia treated by the therapeutic regimen of watchful waiting during a twenty-four-month follow-up period / 中华流行病学杂志

Objective To analyze the changes of the main clinic parameters in patients with benign prostate hyperplasia (BPH) treated by watchful waiting and to find out the risk factors contributing the progress of BPH. Methods According to the inclusion and exclusion criteria, 61 patients diagnosed as BPH were recruited in the group of watchful waiting. Data on IPSS, prostate volume, prostate specific antigen(PSA), maxium flow rate, average flow rate and residual urine volume during follow-up period of 24 months, were recorded. Results At 0, 12, 24 months, the IPSS, prostate volume (ml), PSA(ng/ml),maxium flow rate (ml/s) were 7±4, 4±3, 4±3 ; 33.0±9.0, 33.8±7.6, 30.9±6.8 ; 1.53±1.35,1.43±0.95, 1.22±0.99; 17.1±5.0, 17.2±6.1, 19.2±8.0, respectively. At the end of the 24-months follow-up, all observed parameters had a little improvement except the average prostate volume in this group. Of the 61 patients, 42(62%) progressed slowly or became better when comparing with baseline data of the study. Moreover, the difference between at 24-month and at baseline period, IPSS showed statistical significance (P＜0.0001) in t test. In the study of BPH progression risk factors by logistic regression analysis, prostate volume( P = 0. 0910) and residual urine volume( P = 0. 0780) showed a trend of becoming the risk factors. Conclusion Our study showed that patients treated with watchful waiting had slow progression and majority of these patients did not need to alter their treatment options.Through data analysis, we noticed that the changes of data watchful waiting patients could help us to choose more precise and reasonable treatment option in clinical pratice.[ Key words ] Benign prostate hyperplasia; Prostate volume; Residual urine; Watchful waiting;Follow-up

Transperitoneal laparoscopic adrenalectomy: surgical approach and outcome / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the efficiency and safety of transperitoneal laparoscopic adrenalectomy for the treatment of adrenal tumors and to describe surgical technique and management of intraoperative complications.</p><p><b>METHODS</b>From February 2002 to April 2008, 24 male and 44 female consecutive patients with average age (53.4 +/- 12.1) years old were treated with transperitoneal laparoscopic adrenalectomy because of adrenal tumors. Of the patients, 27 cases had right adrenal tumors, 39 cases had left adrenal tumors and 2 cases had bilateral adrenal tumors. The average tumor size was (2.9 +/- 2.0) cm with the maximal diameter of 10 cm. We evaluated this technique in respect of operating time, estimated blood loss, complications during surgery, postoperative complications, duration of hospital stay and pathological results.</p><p><b>RESULTS</b>All the surgeries had been completed successfully without conversion to open surgery. The average operating time was (157.7 +/- 51.5) min, the average estimated blood loss was (68.1 +/- 54.2) ml. No major complication happened during operation. The average drainage time was (2.6 +/- 1.5) days. The average post-operative hospital stay was (8.7 +/- 4.3) days. Four cases (6.0%) developed surgical field liquefaction and 2 cases (2.9%) experienced delayed closure of the drainage wound.</p><p><b>CONCLUSIONS</b>Transperitoneal laparoscopic adrenalectomy is feasible and safe in the treatment of adrenal tumor with low risk of intra-operative and post-operative complication.</p>

Photoselective green-light laser vaporization of the prostate with volume more than 80ml / 中华老年医学杂志

Objective To analyze the safety and effectiveness of photoselective green-light laser vaporization of the prostate(PVP)in treatment of large prostate with volume more than 80 ml. Methods Retrospective analysis was performed in 25 benign prostatic hypertrophy patients undergoing the PVP treatment,whose prostate volume was more than 80 ml.Results Twenty-five patients with prostate mean volume of 151.8(84.0-270.0)ml were treated by PVP and 23 cases were finished successfully.One operation was suspended because of bleeding and the other because of damaging orifice.No blood transfusion was needed and no“transurethral resection(TUR)syndrome”happened.Five cases had acute retention and 2 of them needed second PVP.In a mean of 7.9(3.0- 12.0)months follow-up,maximal urinary flow rate(Qmax),international prostate symptom score (IPSS),quality of life score(QOL),and prostate-specific antigen(PSA)level were improved significantly.The volume of prostate reduced after PVP than before PVP but no significant difference was found.Conclusions PVP is feasible in treating large prostate even the volume is more than 80 ml,although it needs better skill.Catheterization for some time is helpful in reducing the incidence of early postoperative acute urinary retention.

Diagnosis and treatment of prostate cancer with prostate specific antigen 4-10?g/L / 中华老年医学杂志

Objective To investigate the diagnostic and therapeutic characteristics of prostate cancer with prostate specific antigen(PSA)4-10?g/L. Methods The data of prostate biopsies for the patients with PSA 4-10?g/L from May 1998 to February 2004 and the treatment and prognosis of these patients were retrospectively analyzed. Results In the 141 cases, 34 were diagnosed as prostate cancer, including 3 cT1, 21 cT2, 6 cT3 and 4 cT4. Mean Gleason score was 5.8, and the mean Gleason scores of cT1 and cT2 were significantly lower than those of cT3 and cT4. Twenty-four cases of cT1 and cT2 underwent radical prostatectomy. Four cases of cT3 recieved radical prostateetomy after 4 months of neoadjuvant endocrine therapy. Two cases of cT3 and 4 cT4 received castration. Pathological section from radical surgeries showed that 21 cases were organ confined and 7 were locally invasive. The difference of mean Gleason score between these two groups was significant in statistics. After 18 to 69 months (mean 42 months)follow-up, 21 organ confined cases were free survived, 4 locally invasive cases had biochemical recurrence and 1 case had multifocal bone metastasis. No cancer-specific death happened. Two of 4 cT4 cases were still alive and 2 died of the tumor. Conclusions Routine needle biopsy is necessary for the cases with“grave area”PSA of 4～10 ?g/L. Prostate cancers with PSA 4～10/?g/L are not always early diseases. Gleason score is a very important index for determine the stage of pathology after surgery. Radical prostatectomy is an effective treatment for organ confined disease.