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Objective:To investigate the diagnostic value of the combination of 18F-prostate specific membrane antigen (PSMA) PET/CT and multiparametric magnetic resonance imaging (mpMRI) in identifying the grade group of prostate cancer, using parameters derived from the two imaging modalities. Method:Prostate cancer patients diagnosed by histopathology and received 18F-PSMA PET/CT and mpMRI during September 2018 to May 2021 in our hospital were retrospectively studied. The median age was 68(64-75), with the median PSA level of 14.74(7.75-24.19)ng/mL. All patients received mpMRI before biopsy. On biopsy, 6(12.2%) patients had International Society of Urological Pathology grade group(ISUP GG) 1 diseases, 16(32.7%) had ISUP GG 2 diseases, 12(24.5%) had ISUP GG 3 diseases, and 15(10.9%) had ISUP GG 4 or 5 diseases. Patients were then divided into high-grade group (ISUP 4-5) and low-grade group(ISUP 1-3). The median age of patients in high-grade group and low-grade group were 65(62-76) and 71(65-74), respectively. The PSA level in high-grade group and low-grade group were 15.11(6.63-42.86) ng/ml and 12.31(7.94-18.25) ng/ml, respectively. No significant differences were found in age and PSA level between the two groups ( P=0.334, P=0.448). All patients underwent 18F-PSMA PET/CT within 4 weeks after biopsy. The maximum standardized uptake value(SUV max) and the minimum apparent diffusion coefficient(ADC min)were recorded, and the ratio of SUV max/ ADC minwere calculated. The correlation between the above parameters and ISUP grade group were analyzed.The diagnostic value of the parameters was evaluated by the receiver operating characteristic (ROC) curve. Results:The data of 49 patients were analyzed. The average ADC minwas (0.57±0.16)×10 -3 mm 2/s, with the average SUV max and SUV max/ADC min of 15.30±12.54 and (29.69±23.72)×10 3, respectively. Statistical differences were found in SUV max ( P=0.012) and SUV max/ADC min ( P=0.002) between the high- and low-grade groups, while ADC min ( P=0.411) showed no statistical differences between the two groups. Significant positive correlations were found between SUV max(r=0.501, P<0.001), SUV max/ADC min (r=0.527, P<0.001) and ISUP grade group, respectively. There was a negative correlation between ADC min and ISUP grade group (r=-0.296, P=0.039). SUV max/ADC min was the best index to distinguish high-grade group from low-grade group prostate cancer with the area under the curve(AUC) of 0.749. In contrast, the AUC of SUV maxand ADC min were 0.731 and 0.615, respectively. The diagnostic sensitivity and specificity of SUV max/ADC min were 73.3% and 85.3%, respectively, with a critical value of 37.23×10 3. Conclusion:The combination use of 18F-PSMA PET/CT and mpMRI could improve the diagnostic efficiency for prostate cancer, compared to either modality alone. The ratio of SUV max/ADC min has a positive correlation with ISUP grade group, and is a promising index for distinguishing the high-grade prostate cancer from low-grade cancer.
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Objective:To analyze the prognosis of patients with positive resection margin after radical prostatectomy, as well as the prostate-specific antigen (PSA)level and risk factors for PSA progression.Methods:A retrospective analysis was performed on the data of 141 patients with pathologically diagnosed prostate cancer who underwent RP from May 2012 to August 2020 in Beijing Hospital. The mean age was (67.4±6.7)years, the preoperative median PSA was 9.6 (1.4-152.8) ng/ ml and the median follow-up time was 56 months. Postoperative pathology was T 2 stage 74 (52.5%), T 3 stage 63 (44.7%), T 4 stage 4 (2.8%). Biochemical recurrence after radical resection was defined as PSA rose to more than 0.2 ng/ml and showed an upward trend after two consecutive follow-ups. In this study, serum PSA ≥ 0.1 ng/ml without biochemical recurrence after radical operation was defined as PSA progression. The PSA level, risk factors of PSA progression and prognosis of patients with positive resection margin were analyzed. Univariate and multivariate Cox regression analysis was used to analyze the correlation between age, preoperative PSA level, pathological stage (pT), ISUP classification, surgical approach, lymph node dissection, single/multiple positive margins and PSA progression. Results:The median follow-up of 141 patients was 52 months(1-104 months). There were 69 (48.9%) patients in the PSA progression group and 72 (51.1%) patients in the non PSA progression group. In the PSA progression group, 13 (18.8%) patients did not receive treatment and 8 (61.5%) patients had biochemical recurrence. 4 (5.8%) patients received radiotherapy alone, and 2 (50.0%) patients had biochemical recurrence. 52 (75.4%) patients received endocrine therapy or endocrine therapy combined with radiotherapy, and 5 (9.6%) patients developed castration resistance. Multivariate Cox regression analysis showed preoperative PSA ( HR=1.015, 95% CI 1.005-1.025, P =0.004), ISUP grade and group ( HR=1.351, 95% CI 1.091-1.673, P =0.006), surgical method ( HR=2.233, 95% CI 1.141-4.370, P =0.019) was correlated with PSA progression. Conclusions:The incidence of surgical positive margin is high after RP. Nearly half of the patients with surgical positive margin developed a PSA progression status. Preoperative PSA, ISUP grade group, and the surgical approach are risk factors for PSA progression in patients with positive surgical margins. Patients with these risk factors should be monitored more closely and treated more aggressively.
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Objective:To investigate the features of volume, distribution, grading and staging of prostate cancer(PCa)examined via whole-mount histopathology in transitional PCa.Methods:A total of 129 PCa patients undergone radical prostatectomy(RP)between July 2017 and March 2020 whose whole-mount prostate specimens were prepared after surgery were retrospectively studied.Pathological data on tumor locations, diameters and classification of the International Society of Urologic Pathology(ISUP), radiological data on regions of interest(ROI)and scores of the Prostate Imaging and Reporting Data System(PI-RADS v2)were recorded.The results of pathological whole-mount sections and prostate imaging were compared, and the characteristics and detection rates of lesions in different prostate regions were analyzed.Results:Of all 129 prostate specimens from RP, a total of 213 PCa lesions were detected through whole-mount histopathology.There were 21(9.9%)lesions involving both the peripheral zone(PZ)and the transition zone(TZ), with an average diameter of(2.82±0.71)cm.Of all lesions, 85(39.9%)involved PZ and 107(50.2%)involved TZ, with an average diameter of(1.36±0.81)cm and of(1.60±0.94)cm, respectively.The percentage of lesions involving TZ was higher than that lesions involving PZ, with larger diameters( P<0.05). Of 64 patients with complete MRI data, 105 PCa lesions were detected histopathologically by using whole mount sections, while 75 PCa lesions were detected by MRI, with a statistical difference( P<0.05). For lesions≥1.0 cm or lesions with an ISUP grade group≥2, the detection rate of MRI was lower in TZ lesions( P<0.05). Conclusions:PCa lesions within TZ account for a large proportion and have a relatively large tumor dimeter.PCa lesions within TZ are more likely to be missed in clinical examinations and on MRI, and clinicians should pay close attention during diagnosis and treatment.
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Objective To explore the factors affecting the effect of first stage treatment of sacral neuromodulation.Methods A retrospective analysis of 39 patients with dysuria related diseases from April 2012 to January 2016 was performed.There were 14 male patients and 25 female patients.Their age ranged from 15 to 86 years old,mean 54 years old.The types of disease were bladder pain syndrome/interstitial cystitis in 1 8 cases,idiopathic urinal retention in 5 cases,overactive bladder in 8 cases,neurogenic bladder in 6 cases,and urgent incontinence in 2 cases.All patients were treated by behavioral therapy,drug therapy,and at least one recomnended treatment method.All previons treatments were ineffective.All patients were collected baseline medical records.The voiding diary,visual analogue pain score,quality of life score,anxiety score and other information before and after the first stage surgery and the last follow-up after the second stage surgery were also collected.Results A total of 39 patients were enrolled in this study.27 patients (69％)who were satisfied with the effect of the first stage of surgery were treated with the second stage surgery,and 12 patients (31％)who were not satisfied with the results of the first phase operation did not undergo the second phase operation.The second stage implantation rate was 69％.The average experience time was (21.6 ± 3.0) days.In the single first stage implantation group,there were 6 males and 6 females,including interstitial cystitis in 3 cases,overactive bladder in 3 cases,neurogenic bladder in 4 cases,idiopathic urinary retention in 1 cases and urgent incontinence in 1 cases.2 cases have a history of pelvic and urinary surgery and 10 cases dont.The average BMI was 21.8 ± 3.7 kg/m2,and mean age was(44.5 ± 19.1) years old.The average preoperative anxiety score was 33.7 ± 5.3 and the average pain score of preoperative was 8.0 ± 1.0.The average quality of life score was 4.6 ±0.8 and the average daily nunber of urine was 23.1 ± 12.8.The average mean urine volume was (89.4 ± 33.0) ml,the average frequency of nocturia was 10.3 ± 5.5,the average medical history time was (100.6 ± 125.5) months.In the second stage implantation group,there were 8 males and 19 females,including interstitial cystitis in 15 cases,overactive bladder in 5 cases,neurogenic bladder in 2 cases,idiopathic urinary retention in 4 cases,and urgent incontinence in 1 cases.10 cases have a history of pelvic and urinary surgery while 17 cases don't.Average BM1 was (24.1 ± 2.6) kg/m2,and mean age was(57.9 ± 16.8) years old.The average preoperative anxiety score was 27.7 ± 5.9,the average pain score of preoperative was 7.9 ± 1.6.The average quality of life score was 5.3 ± 0.9 the average daily urinary number was 30.6 ± 14.2.The average mean urine volume was (64.8 ± 37.4) ml and the average frequency of nocturia was 13.3 ± 9.2.The average history of time was (83.0 ± 56.0) months.Patients who were implanted with permanent sacral neuromodulation system were mostly older (P =0.034),with higher BMI (P =0.043) and lower anxiety (P =0.008).There were no statistically significant differences in gender(P =0.287),disease(P =0.116),the daily urinary frequency (P =0.140),the average urine volume (P =0.470),nocturia freqnency (P =0.068),pain scores (P =0.880),surgical history (P =0.276)and the medical history time (P =0.116) between patients who underwent first stage surgery only and second stage surgery.Conclusion BMI,age and anxiety may be the factors that affect the outcome of the first stage treatment of sacral neuromodulation.
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Objective To investigate the histopathological characteristics of metastatic castration-resistant prostate cancer.Methods Clinical findings,morphologic features,immunophenotypes of androgen receptor (AR),prostatic specific antigen (PSA),chromogranin A (CgA),and phosphatase and tensin homolog deleted on chromosome ten(PTEN)(by EnVision method) of 178 core biopsies from patients with metastatic castration resistant prostate cancer encountered from January 2010 to January 2015 from West Coast Dream Team were analyzed.Results In the 178 cases,51(28.7％)were diagnosed with typical adenocarcinoma,41 cases(23.0％)with intermediate atypical carcinoma and 24 cases(13.5 ％)with small cell carcinoma.The expression of PSA was significantly lower in patients with intermediate atypical carcinoma or with small cell carcinoma(31/39,79.5 ％) than in those with adenocarcinoma(20/20,100 ％).The expression of PTEN was significantly higher in patient with intermediate atypical carcinoma or with small cell carcinoma (31/46,67.4％) than in those with adenocarcinoma (19/41,46.3％).Conclusions Three histopathological subtypes exists in metastatic castration-resistant prostate cancer,including adenocarcinoma,intermediate type atypical carcinoma and small cell carcinoma.They are entities with unique pathological features.The expression of PTEN is significantly lower in the patients with intermediate atypical carcinoma or with small cell carcinoma than in those with adenocarcinoma,indicating that intermediate atypical carcinoma and small cell carcinoma are different from typical adenocarcinoma in tumor occurrence and progression.
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Porcine alveolar macrophages (PAMs) represent the first line of defense in the porcine lung after infection with porcine circovirus type 2 (PCV2) via the respiratory tract. However, PCV2 infection impairs the microbicidal capability of PAMs and alters cytokine production and/or secretion. At present, the reason for the imbalance of cytokines has not been fully elucidated, and the regulatory mechanisms involved are unclear. In this study, we investigated the expression levels and regulation of interleukin-1beta (IL-1β) and IL-10 in PAMs following incubation with PCV2 in vitro. Levels of IL-1β and IL-10 increased in PAM supernatants, and the distribution of nuclear factor kappa B (NF-κB) p65 staining in nucleus, expression of MyD88 and p-IκB in cytoplasm, and DNA-binding activity of NF-κB increased after incubation with PCV2, while p65 expression in PAM cytoplasm decreased. However, when PAMs were co-incubated with PCV2 and small interfering RNA targeting MyD88, those effects were reversed. Additionally, mRNA expression levels of Toll-like receptors (TLR)-2, -3, -4, -7, -8, and -9 increased when PAMs were incubated with PCV2. These results show that PCV2 induces increased IL-1β and IL-10 production in PAMs, and these changes in expression are related to the TLR–MyD88–NF-κB signaling pathway.
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Circovirus , Cytokines , Cytoplasm , In Vitro Techniques , Interleukin-10 , Interleukin-1beta , Lung , Macrophages, Alveolar , NF-kappa B , Respiratory System , RNA, Messenger , RNA, Small Interfering , Toll-Like ReceptorsABSTRACT
Objective To investigate the pathological features of chronic inflammation in prostatic specimens,and study the correlation of chronic prostatic inflammation with prostate cancer and hyperplasia of prostate in the elderly.Methods The histopathologic features of prostatic specimens which were taken during prostatectomy were retrospectively observed.The inflammatory cells in partial cases were labeled by immunohistochemical markers such as CD3,CD20,CD4,CD8,CD117 and CD138,and by inflammation related factors such as nuclear factor(NF)-κB,(COX-2),tumor necrosis factor-α(TNF-α)and inducible nitric oxide synthase (iNOS).Results The chronic prostatic inflammation of different extent were found in 100 patients with prostate cancer and 76 patients with benign prostatic hyperplasia,among them 71 cases (40.3 ％) had mild chronic prostatic inflammation,80 cases (45.5 ％) had moderate chronic prostatic inflammation,25 cases (14.2 ％) had severe chronic prostatic inflammation.Inflammatory cells mainly were CD3-labeled lymphocytes,accompanied by a small amount of mononuclear cells and mast cells.Chronic prostatic inflammation was not correlated with prostatic carcinoma and its differentiation degree,benign prostatic hyperplasia,focal atrophy and its subtypes,and high grade prostatic intraepithelial neoplasia (all P＞ 0.05).There was correlation between chronic prostatic inflammation and expression of COX-2 (P＜ 0.05).Conclusions The histological chronic inflammation is common in the prostate specimens in elderly men.There are no direct correlations of prostatic inflammation with prostatic carcinomas and benign prostatic hyperplasia.Prostatic inflammation is positively correlated with the expression of COX 2,which may be associated with the activation of COX-2 pathway induced by oxidative stress.
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Objective To analyze the correlation factors on bone metastatic rate in prostate cancer patients with prostate specific antigen ( PSA ) less than 20 μg/L.Methods A retrospective analysis was made in 143 prostate cancer patients in Beijing Hospital from March 1997 to December 2013 with PSA less than 20μg/L.Their PSA was 0.05-19.97μg/L and median PSA was 10.72μg/L.According to Gleason score, the patients were divided into three group with Gleason score≤6, 7,≥8.According to T stage, the patients were divided into ≤T2 or ≥T3 .According to PSA, the patients were divided into 66%.The correlation of bone scan with PSA, Gleason score, T stage or percentage of positive cores in biopsy was evaluated.Results The bone metastatic rate of each group with Gleason score was 6 ( 9.5%) , 8 ( 16.0%) and 7 ( 23.3%) , respectively.There was significant difference among them ( P=0.025 ) .According to T stage, the positive rate of each group was 6(7.1%) and 15(25.9%), and there was significant difference between them (P=0.036).According to PSA, the positive rate of each group was 2 ( 18.2%) , 9 ( 13.0%) , and 10 ( 15.9%) and there was no significant difference (P=0.153).According to percentage of positive cores on the bone scan, the positive rate of each group was 6 ( 8.8%) , 9 ( 19.1%) and 6 ( 21.4%) and there was no significant difference ( P=0.862).Conclusions In prostate cancer patients with PSA less than 20 μg/L, Gleason score and T stage are significantly correlated with bone metastatic rate.However, bone metastatic rate had no correlation with PSA and percentage of positive cores in biopsy.
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Objective To study the characteristics of different papillary renal cell carcinoma (PRCC)subtypes and their prognosis after nephrectomy.Methods Clinical data of 14 PRCC patients(7 males,7 females)with ages ranging from 20-77 in our institute from 2005 to 2011 were retrospectively reviewed.There were 5 tumors in the left kidney and 9 tumors in the right kidney.The average maximum tumor diameter was 3.8(1.6-7.8)cm.Patients presented with gross hematuria(n =3),flank pain(n =3),palpable abdominal mass(n =1)or asymptomatic(n =7).The TNM stages were 8 T1aN0M0,2 T1bN0M0,1 T1aN0M1,1 T2aN0M0,1 T3aN0M0 and 1 T3aN1 M0.Six patients were treated with radical nephrectomy,8 cases were treated with partial nephrectomy.Results There were 6 type Ⅰ and 8 type Ⅱ PRCCs cases.In pathology,type Ⅰ PRCC showed papillae covered by small cells with scanty basophilic cytoplasm,and arranged in a single layer on the papillary basement membrane with low nuclear grade.Type Ⅱ PRCC was composed of cells with higher nuclear grade,abundant eosinophilic cytoplasm,and pseudostratified nuclei on papillary cores.There were 12 well-differentiated cases,2 moderate-differentiated cases and no poorly differentiated case.Follow-up was carried out from 12to 80 months.During the follow-up,1 patient with type Ⅰ PRCC developed multiple lung metastases 26 month after surgery and deteriorated into hepatic and bone metastases at 34 month after surgery.We offered the patient with targeted therapy and the patient was still alive.There was 1 type Ⅱ PRCC patient died with multiple metastases at 42 month after surgery.Others were still alive without local recurrence and metastasis.Conclusions PRCC is not a common subtype of renal cell carcinoma in China.Early stage PRCC patient would achieve good prognosis after treated with nephrectomy.Targeted therapy is a good treatment option for metastatic papillary renal cell carcinoma patients.
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Objective To evaluate the efficacy and safety of tension free vaginal tape obturator technique (TVT-O) in females stress urinary incontinence (SUI).Methods From June 2008 to May 2012,156 cases of female SUI were treated with TVT-O procedure in our hospital.The mean age is 56.3 ±13.9 years.There were 79.5％ patients who suffered simple SUI while 20.5％ patients with SUI and urge urinary incontinence (UUI).The mean follow-up time was 16.5 months.All patient’s ICI-Q-SF scores and I-QOL scores were collected.The efficacy and safety of TVT-O were analyzed.Results The mean operative time was 34 ± 11 minutes and the mean estimated blood loss were 15 ± 9 ml.One hundred and forty-five cases were cured with TVT-O (92.9％) while 8 cases were improved (5.1％).The preoperative and postoperative ICI-Q-SF symptom scores were 8.2 ± 2.1 and 0.5 ± 1.3 while the I-QOL life quality scores were 28.5 ± 10.3 and 69.8 ± 9.9 respectively.There was statistical difference between the preoperative and postoperative scores (P ＜ 0.05 ).No bladder injury was recorded during the procedures.There were two cases whose vaginal walt were injured and repaired intraoperatively.No pelvic hematoma,long-term pain,sling erosion,infection and fistula were found in all cases.Three cases ( 1.9％ ) suffered temporary urinary retention and were cured by two weeks urethral catheterization.Conclusions TVT-O technique seems to be an easy and minimally invasive procedu(r)e with less complication,which supports its safety and reliability in the treatment of female SUI.
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Objective To verify the safety and feasibility of applying transperitoneal laparoendoscopic single-site surgery (LESS) nephrectomy in the treatment of kidney malignant and benign diseases.Methods From Nov.2010 to Jun.2012,we had used LESS nephrectomy technique treated four kidney tumors,one renal pelvic tumor and one atrophic kidney. Quadport was introduced into abdominal cavity through a paraumbilical incision. Conventional laparoscopic instruments,prebent laparoscopic instruments and flexible tip 5mm laparoscope were used. The standard laparoscopic transperitoneal nephrectomy technique was then performed.We evaluated this technique in respects of operative time,estimated blood loss,intraoperative complications,1st post-operative day pain (VAPS),drainage time,post-operative hospital stay and pathological results. Results The 6 procedures in this group were completed successfully with LESS nephrectomy. There was no additional trocar added,no conversion to conventional laparoscopic or open surgery.Application of Quadport and prebent instruments reduced the clash of instruments,both intracorporally and extracorporally.The average operative time were 181.7 (145.0 -235.0) min,average estimated blood loss were 78.3 (20.0 - 150.0) ml.There was no severe intraoperative complication.The average VAPS in the first post - operative day was 1.7 ( 1.0 - 2.0).The average drainage time was 2.8 ( 1.0 -4.0) d,post-operative hospital stays was 6.8 ( 1.0 - 10.0) d.There was no secondary bleeding or wound infection.Pathological results showed 3 cases of renal clear cell carcinoma,1 case of chromophobic carcinoma,1 case of high-grade urothelial carcinoma and 1 case of atrophic kidney.All the specimens in this group were surgical margin negative. Conclusions LESS nephrectomy is a safe and feasible treatment option for the treatment of kidney surgical diseases.
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ObjectiveTo verify the safety and feasibility of retroperitoneal laparoendoscopic singlesite surgery (LESS) adrenalectomy in the treatment of adrenal gland tumors or cyst.MethodsFrom Oct.2009 to Jan.2012,7 patients underwent retroperitoneal LESS adrenalectomy with Quadport technology by one surgeon.The mean patient age was 46 ( 39 - 55 ) years.The mean largest tumor diameter was 2.3 (1.8-3.6) cm.All procedures were performed through retroperitoneal approach by using Quadport,tip flexible laparoscope with 0° lens and conventional laparoscopic instruments.This technique was evaluated in respects of operative time,estimated blood loss,intraoperative complications,drainage time,visual analog pain scale (VAPS) score,post-operative hospital stay and pathological results.ResultsSeven cases of LESS adrenalectomy were completed successfully.There was no additional trocar added,no conversion to conventional laparoscopic or open approach.The mean operative time was 106 (70 - 180) min,and the mean estimated blood loss was 59 (5 -200) ml.The mean first day post-operative VAPS score was 2 (1 -3),drainage time was 2 (2 -3) d.Post-operative hospital stay was 5 (3 -6) d.No perioperative complication was observed.Pathological results showed 1 case of adrenal pheochromocytoma,5 cases of adrenal cortical adenoma and 1 case of adrenal cyst.ConclusionRetroperitoneal LESS adrenalectomy is a safe and feasible option for the treatment of adrenal tumors and cyst.
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Objective To evaluate the influences of prostate-specific antigen (PSA) and digital rectal examination (DRE) to the detection rate,stage and Gleason grade of prostate cancer.Methods Retrospective analysis was performed on the prostate biopsy data of Beijing hospital from January 1997 to December 2010.The spearman rank correlation was applied to evaluate the relationship of PSA and DRE to the parameters related to the prostate cancer.Results The PSA had significant correlation with cancer detection rate,stage and Gleason grade (r =0.537,P ＜0.0001; r =0.365,P ＜0.0001; r=0.556,P ＜0.0001).However,DRE had only correlation with cancer detection rate and Gleason grade (r =0.212,P ＜0.0001 ; r =0.126,P =0.02).As the PSA increased,when divided into different groups,the cancer detection rate and the proportion of patients with Gleason 7-10 increased whereas the localized cancer rate decreased.DRE positive patients had higher cancer detection rate when PSA was in 10.0-19.9 μg/L and 20.0-99.9 μg/L groups.The DRE results had no influence to the stage or Gleason grade in same PSA group.Conclusions PSA has significant correlation with prostate cancer detection rate,stage and Gleason grade.However,the DRE results only affect cancer detection rate in some PSA level.
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Objective To evaluate the real-life clinical characteristics of benign prostatic hyperplasia (BPH) patients with moderate and severe enlarged prostate. Methods From February 2009 to January 2011,a prospective,non-interventional,multi-center study was conducted on 2 758 BPH patients recruited from 32 hospitals in 10 cities nationwide with the following criteria:prostate volume (PV) larger ≥30 ml and international prostate symptom score (IPSS) ≥ 8. Patient age,PV,IPSS,Qmax medical treatment patterns and physician prescription practice were recorded. The demographic information and clinic characteristics were evaluated as well. Results The mean patient age,PV,IPSS score and Qmax of 2 786eligible patients were 69.2 ±8.5 years (50 to 97 years),47.8 ±16.6 ml (30 to 165 ml),17.5 ±5.4 (8to 35 ) and 11.6 ± 3.6 ml/s (2 to 36 ml/s),respectively.Age subgroup analysis pointed that the mean PV and Qmax in 50 -55 years group were 42.8 ml and 13.3 ml/s compared to 49.0 ml and 11.1 ml/s in the group beyond 71 years.Both parameters had statistical significances (P ＜ 0.05 ). For 56.1％ of the patients,it was their first time coming to clinic seeking for medical advice. Of whom,22.8％ patients had taken BPH prescription medication regularly beyond two weeks.Only 31.3％ of the patients had a history of BPH shorter than one year.22.9％ and 18.3％ of the patients had a history of BPH for 1 -2 and 3 -4 years.And 27.5％ of the patients had a history of BPH related symptoms longer than five years. Only 52.6％ patients were treated with α adrenoceptor antagonists + 5-α reductase inhibitor by urologists according to the recommendation in Chinese guideline of BPH. Conclusions The symptoms and key parameters of moderate and severe benign prostatic hyperplasia (BPH) patients become worse and more with increased age in China.It is quite late for most patients coming to clinic seeking for their first medical advice.Furthermore,there is a huge gap between urologist prescription and the recommendation of the Chinese guideline on BPH.
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Objective To verify the clinical safety and feasibility of applying laparoendoscopic single-site surgery (LESS) in the treatment of elder patients with urological tumors. Methods From August 2010 to March 2011, LESS technique was used to do prostatectomy in five cases, nephrectomy in 3 cases and adrenalectomy in four cases. Quadport was inserted through a transumbilical incision. Flexible tip 5 mm laparoscope and standard laparoscopic instruments were employed. This technique was evaluated in respects of operative time, estimated blood loss, intraoperative complications, drainage time, post-operative visual analogue pain scale (VAPS), post-operative hospital stay and pathological change. Results All the procedures in this group were completed successfully with LESS. There was no additional trocarand conversion to standard laparoscopic or open surgery. Application of Quadport reduced the clash of instruments. Carefully performing surgery and avoiding blunt dissection to reduce intraoperative bleeding is the cornerstone of success. The operative time and estimated blood loss were (192.0±76.7) min and (174.6±167.2) ml, respectively. There was no severe intraoperative complication and blood transfusion. The VAPS in the first post-operative day was (0.9 ± 1.0) minutes and the drainage time was (3.5±1.7) d while post-operative hospital stays were (7.9±3.4) d. There was no occurrence of secondary bleeding and wound infection. Conclusions LESS is a safe and feasible alternative for the treatment of urological tumors in elderly patients, but needs further clinical investigation.
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Objective To verify the safety and feasibility of applying laparoendoscopic singlesite radical prostatectomy (LESS-LRP) in the treatment of prostate cancer. Methods From Sept. to Dec. 2010, LESS-LRP was used to treat 2 early stage prostate cancer patients. The LESS-LRP was preformed through extra-peritoneal approach by using standard laparoscopic instruments and a 5 mm flexible laparoscope. This technique were evaluated in respects of operative time, estimated blood loss, intraoperative complications, drainage time, post-operative pain score (VAPS), post-operative hospital stay, pathological results and post-operative PSA levels. Results All procedures of the 2cases were completed with LESS-LRP without conversion to standard laparoscopic or open radical prostatectomy. The operative times for LESS-LRP were 280 and 285 min, estimated blood loss were 400 and 200 ml, respectively. There was no severe intraoperative complication. The drainage times were 2 and 6 d, the VAPS in the first post-operative day were 1 and 0, and post-operative hospital stay were 14 and 7 d. There was no secondary bleeding or wound infection. The 2 prostate cancer cases were all in pathological stage pT2c N0 M0. Surgical margins of the specimens were negative. The first case showed PSA of 0. 033 ng/ml 1 month after the surgery. Conclusion LESS-LRP can be an exploratory option in clinical for the treatment of prostate cancer.
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Objective To realize and analyze the current status of medical treatment for benign prostatic hyperplasia in special clinic for elderly in China.Methods The informations were gathered from 34 clinics for elderly located in 11 Chinese cities from February 2008 to September 2008.First, all male patients who visited the clinic were inquired about their history of benign prostatic hyperplasia , and then 1000 benign prostatic hyperplasia patients who were receiving medical treatment were selected to finish a detailed questionnaire and to get several examinations for benign prostatic hyperplasia.Results Among the 1000 patients, 774 completely finished the questionnaire, patients with middle or severe international prostate symptom score (IPSS) and with high volume of prostate occupied a large proportion.Medical treatments included the combined therapy of α-blockers plus 5α reductase inhibitors (45.48 %), α-blockers (36.30%), 5α reductase inhibitors (13.05 %) and other medicines (including phytotherapeutic agents and traditional medicines, 5.17%).Conclusions Nowadays in China, as to the prescription for benign prostatic hyperplasia in the clinic for elderly presents, doctors only concentrate on the improvement of symptoms, whereas ignore the progression of the disease.There is still a considerable gap between real medical treatment and international guidelines.Therefore, improvements of medical treatment are still needed in the future clinical practice.
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Objective To explore the classification and risk factors of nocturia in patients with benign prostatic hyperplasia (BPH). Methods The 120 males aged 60 years old and over were enrolled who were first diagnosed as BPH or had ceased the BPH medication for at least 3 months.The patients were divided into six groups according to the nocturnal voiding episodes estimated according to the international prostate symptom score (IPSS). All 120 males were inquired about general information and medical histories. The time and volume of intake and voided urine were recorded for 72 hours. The indexes of prostate and bladder function in all cases were also examined and recorded. Results The incidence of nocturia in our study was 79.2%, the incidence of nocturnal polyuria and overactive bladder were 3.3% and 10.8%, respectively. The quality of life was affected by the duration between the time of patients' going to bed and the first time getting up at night. After excluding the cases of nocturnal polyuria and overactive bladder, statistical analysis indicated that the age, and residual urine volume of the bladder were positively associated with nocturia frequencies (NF), the nocturnal voiding volume negatively with NF, while the prostate volume and peak flow rate were not associated with NF. Drinking volume in 24-hours affected the nocturia (P＜0. 01). Conclusions Nocturia is a common complaint in elderly males with BPH and significantly affects the quality of life. The age and the storing function of bladder are more important factors as compared with prostate hyperplasia itself.
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Objective To evaluate the diagnostic and therapeutic status of lower urinary tract symptoms(LUTS)/benign prostatic hyperplasia (BPH) (LUTS/BPH) in outpatient department for elderly patients, and to understand the patients' attitude and knowledge on the disease. Methods The investigation was conducted in 34 outpatient departments for elderly patients located in 11 cities from February to September 2008. The male patients who came to the clinic during the survey time were investigated whether they had LUTS /BPH history or not. Then some eligible patients were chosen to accept a more detailed questionnaire and BPH-related examinations. Results There were 31371 male patients who came to the clinic. 47.0% of them (14748 cases) had the history of LUTS / BPH, and 72.4 % (10678 cases) had medical or surgical treatments presently or previously, whereas 27.6% were untreated. The three most commonly performed examinations in clinical practice were urinalysis, prostate specific antigen (PSA) and transabdominal ultrasonography. In 3542 patients receiving medical investigation, 32.6% (1155 cases) were given 5a reductase inhibitor, and 35.0% (1239 cases) received a combination therapy of 5a reductase inhibitor plus a receptor blocker. 84.5 (1796 cases) and 79.0% (1678 cases) of all the patients were satisfied with the examinations and treatments respectively. Conclusions LUTS and BPH are common in outpatient department for elderly patients. There are discrepancies of examinations and medical treatments between real medical practice and international suggestion, and the patients' understanding of the disease should be improved