A dosage regimen of M-receptor blocker after TURP for severe BPH with predominant urine storage symptoms / 中华男科学杂志

Objective@#To study the dosage regimen of oral M-receptor blocker following transurethral resection of the prostate (TURP) for severe benign prostate hyperplasia (BPH) with predominant urine storage period symptoms (USPSs) and its clinical effect.@*METHODS@#Severe BPH patients with predominant USPSs received oral tolterodine (2 mg q12d or 4 mg qd) 6 hours after TURP for 4 weeks. The medication continued for another 2 weeks in case of recurrence of USPSs or until the 12th week in case of repeated recurrence. Before and at 1, 4, 8 and 12 weeks after TURP, we analyzed the International Prostate Symptoms Score (IPSS), quality of life (QoL) score, maximum urinary flow rate (Qmax), and postvoid residual volume (PVR) of the patients.@*RESULTS@#Complete clinical data were collected from 106 cases, of which 33 achieved successful drug withdrawal with no aggravation of USPSs at 4 weeks after TURP, 51 at 6－8 weeks, 13 at 10－12 weeks, and 9 needed medication after 12 weeks. Before and at 1, 4, 8 and 12 weeks after TURP, the total IPSSs were 25.33 ± 3.45, 19.33 ± 3.62, 11.56 ± 2.45, 8.38 ± 2.0 and 7.74 ± 1.87, those in the urine storage period were 11.97 ± 1.53, 10.76 ± 1.82, 6.16 ± 1.22, 4.08 ± 1.19 and 3.91 ± 1.15, those at urine voiding were 9.80 ± 1.60, 5.59 ± 1.45, 3.40 ± 0.92, 2.85 ± 0.71, and 2.61 ± 0.67, and the QoL scores were 4.70 ± 0.78, 3.92 ± 0.75, 2.55 ± 0.74, 1.83 ± 0.72 and 1.66 ± 0.75, respectively, with statistically significant differences between the baseline and the scores at 1 and 4 weeks (P 0.05). Qmax and PVR were improved progressively and significantly at 1 and 4 weeks (P 0.05).@*CONCLUSIONS@#Four to eight weeks of oral administration of M-receptor blocker may be an effective dosage regimen for severe BPH with predominant USPSs after TURP.

Correlation between Cholinergic Innervation, Autophagy, and Etiopathology of Benign Prostatic Hyperplasia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Whether cholinergic innervations and/or autophagy have a role in the etiopathology of benign prostatic hyperplasia (BPH) is still unknown. This study aimed to investigate the role of cholinergic innervation and autophagy in the etiopathology of BPH.</p><p><b>METHODS</b>Male, 13-week-old spontaneous hypertension rats (spontaneous BPH animal model) were divided into three groups: an experimental group (EG, n = 24), a control group (CG, n = 24), and a normal control group (NC, n = 10). The EG animals were intragastrically injected with tolterodine (3.5 mg/kg, twice a day), CG animals were intragastrically injected with physiological saline, and the NC animals did not receive any treatment. Rats were sacrificed every 4 weeks, and the prostatic gross morphological changes, wet weight/body weight (ww/bw), dry weight/wet weight (dw/ww), histological changes, ultrastructural changes, and LC3 immunohistochemistry were continuously observed and compared.</p><p><b>RESULTS</b>The gross morphological and ww/bw changes in the three groups were similar at every stage. The dw/ww (mg/mg) values of the EG at week 17, 21, 25, and 29 were 0.1478 ± 0.0034, 0.1653 ± 0.0036, 0.1668 ± 0.0045, and 0.1755 ± 0.0034, respectively, and the CG values were 0.1511 ± 0.0029, 0.1734 ± 0.0020, 0.1837 ± 0.0052, and 0.1968 ± 0.0045, respectively. The difference between EG and CG for dw/ww showed statistical significance after 21 weeks of age (week 21: P= 0.016, week 25: P= 0.008, and week 29: P= 0.001). Both EG and CG, prostatic glandular epithelial cell proliferation, and secretory function improved with age, but in EG, these improvements were slower than those in CG, and all the differences were statistically significant after 21 weeks. An increasing number of autophagosomes in the prostatic glandular cell cytoplasm, attenuation of LC3-I immunohistochemical staining, enhancement of LC3-II staining, and the ratio of LC3-II/LC3-I staining were all progressive in both groups, but the rate of change in EG was faster than that in CG, and these differences gained statistical significance after 25 weeks. Comparisons with regard to the above indexes between CG and NC showed no statistical significance at any stage.</p><p><b>CONCLUSIONS</b>Cholinergic innervations and activation of autophagy appear to have important functions in the etiopathology of BPH. Drug-mediated blockade of cholinergic innervations could delay the physiopathology processes. Moreover, overactivation of autophagy may also play an important role in this delay.</p>

Efficacy and Safety of Medium-to-long-term Use of Tolterodine Extended Release with or without Tamsulosin in Patients with Benign Prostate Hyperplasia and Larger Prostate Size: A Double-blind, Placebo-controlled, Randomized Clinical Trial / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The medium-to-long-term use of antimuscarinics alone or in combination with an α-blocker in men with an enlarged prostate is still controversial. This double-blind, placebo-controlled, randomized clinical trial aimed to investigate the efficacy and safety of medium-to-long-term use of tolterodine extended release (ER) with or without tamsulosin in patients with benign prostate hyperplasia (BPH) and larger prostate size.</p><p><b>METHODS</b>Totally, 152 patients (age ≥50 years) with BPH, International Prostate Symptom Score (IPSS) ≥12, quality-of-life (QoL) score ≥3, and total prostate volume ≥25 ml were enrolled in this study. The patients were randomized into four groups (n = 38 in each) to receive tolterodine ER placebo plus tamsulosin placebo, 0.2 mg tamsulosin plus tolterodine ER placebo, 4 mg tolterodine ER plus tamsulosin placebo, or tolterodine ER plus tamsulosin once daily for 24 weeks. IPSS (total, storage, and voiding subscales), QoL, maximum urinary flow rate (Qmax), and postvoid residual volume (PVR) were collected at baseline, and at weeks 4, 12, and 24.</p><p><b>RESULTS</b>Compared with placebo, tolterodine ER plus tamsulosin significantly improved total IPSS (-7.15, -12.20, and -14.66 vs. -3.51, -5.78, and -7.23), storage IPSS (-3.56, -5.63, and -6.66 vs. -1.52, -1.21, and -2.43), voiding IPSS (-2.88, -5.10, and -6.48 vs. -1.52, -3.03, and -2.97), QoL (-1.21, -2.40, and -3.21 vs. -0.39, -1.41, and -1.60), Qmax (2.21, 7.97, and 9.72 ml/s vs. 2.15, 2.44, and 2.73 ml/s), and PVR (-17.88, -26.97, and -27.89 ml vs. -12.03, -11.16, and -16.73 ml) at weeks 4, 12, and 24, respectively; the differences were all statistically significant (P < 0.05). Adverse events (AEs) were not increased with treatment progression. Tolterodine ER alone did not improve total IPSS (-4.61, -6.79, and -5.70), voiding IPSS (-0.64, -1.83, and -1.45), QoL (-0.69, -1.21, and -1.41), or Qmax(-0.79, 2.83, and 1.11 ml/s), compared with placebo (all P > 0.05). However, a gradual increase in PVR (10.03, 10.41, and 12.89 ml) and more urinary AEs suggestive of urinary retention (11/38 vs. 4/38) were observed.</p><p><b>CONCLUSION</b>Medium-to-long-term use of tolterodine ER plus tamsulosin should be recommended in patients with BPH and an enlarged prostate volume.</p><p><b>TRIAL REGISTRATION</b>www.chictr.org.cn, ChiCTR-TRC-09000596; http://www.chictr.org.cn/showproj.aspx?proj=8939.</p>

Training for percutaneous renal access on a virtual reality simulator / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The need to develop new methods of surgical training combined with advances in computing has led to the development of virtual reality surgical simulators. The PERC Mentor(TM) is designed to train the user in percutaneous renal collecting system access puncture. This study aimed to validate the use of this kind of simulator, in percutaneous renal access training.</p><p><b>METHODS</b>Twenty-one urologists were enrolled as trainees to learn a fluoroscopy-guided percutaneous renal accessing technique. An assigned percutaneous renal access procedure was immediately performed on the PERC Mentor(TM) after watching instruction video and an analog operation. Objective parameters were recorded by the simulator and subjective global rating scale (GRS) score were determined. Simulation training followed and consisted of 2 hours daily training sessions for 2 consecutive days. Twenty-four hours after the training session, trainees were evaluated performing the same procedure. The post-training evaluation was compared to the evaluation of the initial attempt.</p><p><b>RESULTS</b>During the initial attempt, none of the trainees could complete the appointed procedure due to the lack of experience in fluoroscopy-guided percutaneous renal access. After the short-term training, all trainees were able to independently complete the procedure. Of the 21 trainees, 10 had primitive experience in ultrasound-guided percutaneous nephrolithotomy. Trainees were thus categorized into the group of primitive experience and inexperience. The total operating time and amount of contrast material used were significantly lower in the group of primitive experience versus the inexperience group (P = 0.03 and 0.02, respectively).</p><p><b>CONCLUSIONS</b>The training on the virtual reality simulator, PERC Mentor(TM), can help trainees with no previous experience of fluoroscopy-guided percutaneous renal access to complete the virtual manipulation of the procedure independently. This virtual reality simulator may become an important training and evaluation tool in teaching fluoroscopy-guided percutaneous renal access.</p>

Proficiency of virtual reality simulator training in flexible retrograde ureteroscopy renal stone management / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Minimally invasive flexible ureteroscopy techniques have widely adopted in the management of patients with renal stones. We performed this study to investigate the value of virtual reality simulator training in retrograde flexible ureteroscopy renal stone treatment for catechumen.</p><p><b>METHODS</b>Thirty catechumen, included 17 attending physicians and 13 associate chief physicians, were selected for study. The trainees first underwent 1-hour basic training to get familiar with the instrument and basic procedures, then followed by 4-hour practice on virtual reality simulators. Before and after the 4-hour training, all trainees undertake an assessment with task 7 program (right low pole calyces stone management). We documented for each trainee the total time of procedure, time of progressing from the orifice to stone, stone translocation and fragmentation time, laser operate proficiency scale, total laser energy, maximal size of residual stone fragments, number of trauma from the scopes and tools, damage to the scope and global rating scale (GRS). The proficiency of this training program was analyzed by the comparison of the first and second assessment outcomes.</p><p><b>RESULTS</b>Significant improvement was observed in retrograde flexible ureteroscopy management of renal stone on virtual reality simulators after finishing the 4 hour special-purpose training. This was demonstrated by improvement in total procedure time ((18.37±2.59) minutes vs. (38.67±1.94) minutes), progressing time from the orifice to stone ((4.00±1.08) minutes vs. (13.80±2.01) minutes), time of stone translocation ((1.80±0.71) minutes vs. (6.57±1.01) minutes), fragmentation time ((4.43±1.25) minutes vs. (13.53±1.46) minutes), laser operate proficiency scale (8.47±0.73 vs. 3.77±0.77), total laser energy ((3231.6±401.4) W vs. (5329.8±448.9) W), maximal size of residual stone fragments ((2.66±0.39) mm vs. (5.77±0.63) mm), number of trauma from the scopes and tools (3.27±1.01 vs. 10.37±3.02), damage to the scope (0 vs. 0.97±0.76) and GRS (29.27±2.95 vs. 9.87±2.21). The differences between the first and the second assessment were all statistically significant (all P < 0.01).</p><p><b>CONCLUSION</b>The virtual reality simulator training program can help the trainees to rapidly improve their retrograde flexible ureteroscopy skill in renal stone treatment.</p>

Virtual reality simulator for training urologists on transurethral prostatectomy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>A virtual reality simulator provides a novel training model for improving surgical skills in a variety of fields. They can simulate a variety of surgical scenarios to improve the overall skills required for endoscopic operations, and also record the operative process of trainees in real-time and allow for objective evaluation. At present, some simulators for transurethral resection of the prostate (TURP) are available. The utility of virtual reality simulators in training of transurethral prostatectomy was investigated.</p><p><b>METHODS</b>Thirty-eight urologists were randomly selected to take part in a simulation based training of TURP using the TURPSim(TM) system. Pre and post-training global rate scale (GRS) scores and objective parameters recorded by the simulator were assessed. Then, questionnaires were filled out.</p><p><b>RESULTS</b>Compared with baseline levels, the GRS scores of trainees increased (18.0 ± 4.0 vs. 12.4 ± 4.2, P < 0.001), while the rate of capsule resection (26.3% ± 0.6% vs. 21.2% ± 0.4%, P < 0.001), amount of blood loss ((125.8 ± 86.3) ml vs. (83.7 ± 41.6) ml, P < 0.001), external sphincter injury (3.6 ± 2.9 vs. 2.0 ± 2.0, P < 0.001) decreased significantly after training. Most trainees were satisfied with the simulator based training and believed that the simulator accurately mimicked actual surgical procedures and could help improve their surgical skills.</p><p><b>CONCLUSIONS</b>As a new method of training on transurethral prostatectomy skills, training of TURP using a virtual simulator can help urologists improve their surgical skills and safety. Therefore, the application of the TURPSim(TM) system in education and training of urologic surgery is warranted.</p>

Effectiveness of the UroMentor virtual reality simulator in the skill acquisition of flexible cystoscopy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Virtual reality (VR) has been recognized as a useful modality in the training of surgical skills. With respect to basic endoscopic skill training of urology, we sought to investigate the effectiveness of the UroMentor(TM) virtual reality simulator (VRS) in the skill acquisition of flexible cystoscopy.</p><p><b>METHODS</b>Urologists familiar with rigid cystoscopy procedures were selected to take part in a virtual training course of flexible cystoscopy. Changes in total operating time, frequency of injury, number of digital markers inside the bladder, and the global rating scale (GRS) scores were assessed following eight repeated training sessions on the UroMentor(TM).</p><p><b>RESULTS</b>Eighteen urologists voluntarily took part in the study. Total operating time was significantly lower after eight sessions of training by comparison ((111 ± 10) seconds and (511 ± 67) seconds, respectively; P < 0.001). Additionally, the frequency of injury decreased with training from (12 ± 2) times to (5 ± 1) times (P < 0.001), while the number of digital markers observed increased from 9 ± 0 to 10 ± 1 (P = 0.005). Finally, training with the UroMentor(TM) resulted in a GRS increase from (1.3 ± 0.2) points to (3.9 ± 0.2) points (P < 0.001).</p><p><b>CONCLUSION</b>the VRS UroMentor(TM) can improve urologists' ability to perform flexible cystoscopy and could be used as an effective training tool for trainees.</p>

Efficacy of immediate instillation combined with regular instillations of pirarubicin for Ta and T1 transitional cell bladder cancer after transurethral resection: a prospective, randomized, multicenter study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Immediate intravesical instillation of chemotherapeutic agents after transurethral resection (TUR) of nonmuscle invasive transitional cell bladder cancer has recently been suggested and has been proven to decrease the tumor recurrence rate significantly. This study is to evaluate the efficacy and safety of immediate intravesical instillation combined with regular instillations of Pirarubicin (THP(®)) as prophylaxis compared to regular instillations only after TUR operation.</p><p><b>METHODS</b>This was a prospective, randomized, multi-center, clinical study. Patients diagnosed with non-muscle invasive bladder cancer (Ta and T1) pathologically and suitable for TUR were enrolled randomly into two groups. In the study group, the patients received intravesical instillation within 24-hour post TURBT, followed by regular intravesical therapy using 30 mg/50 ml of THP(®) once a week for 8 weeks, and then once a month to 1 year postoperatively Among the patients. In the control group, patients received regular instillation only.</p><p><b>RESULTS</b>A total of 403 patients were enrolled into this study from 26 institutions in China. Among the potients, 210 were enrolled into the study group and 193 were enrolled into the control group. At the median follow-up of 18 months, the recurrence rate was 7.8% in the study group, significantly lower than that in the control group (14.3%; P = 0.042). Subgroup analysis showed that the recurrence rate in low and intermediate-risk patients was significantly lower in the study group (6.8%) than in the control group (14.0%; P = 0.047), although no significant differences were found in high-risk patients.</p><p><b>CONCLUSION</b>One immediate dose of THP(®) 30 mg after TURBT followed by regular intravesical therapy appears well tolerated and more effective than regular intravesical therapy for preventing tumor recurrence, especially in low and intermediate-risk patients.</p>

Maximal androgen blockade little influences bone mineral density in prostate cancer patients / 中华男科学杂志

<p><b>OBJECTIVE</b>To determine the influence of maximal androgen blockade (MAB) on bone mineral density (BMD) in men with prostate cancer.</p><p><b>METHODS</b>We enrolled 40 men with prostate cancer treated by MAB for 7 to 12 months. We obtained the laboratory results of PSA, testosterone, serum calcium and phosphorus, 24-h urine calcium and phosphorus, alkaline phosphatase, and parathyroid hormone, measured the BMD of the lumbar spine and femoral neck by dual energy X-ray absorptiometry, recorded pain scores, and compared the results before and after the treatment.</p><p><b>RESULTS</b>Before MAB treatment, 5 (12.5%) of the patients met the BMD criteria of lumbar spine (L2-4) osteopenia, 8 (20%) lumbar spine (L2-4) osteoporosis, 13 (32.5%) left femoral neck osteopenia, and 15 (37.5%) left femoral neck osteoporosis. The PSA and testosterone levels were decreased from (52.9 +/- 69.9) microg/L and (18.9 +/- 6.5) nmol/L before MAB to (1.5 +/- 1.6) microg/L and (1.9 +/- 1.3) nmol/L after it (P<0.05). There were no statistically significant differences before and after MAB in the levels of serum calcium and phosphorus, 24-h urine calcium and phosphorus, alkaline phosphatase, and parathyroid hormone (P>0.05), nor in the BMD levels of the lumbar spine ([1.1 +/- 0.1] vs [1.1 +/- 0.2] g/cm2) and femoral neck ([0.8 +/- 0.2] vs [0.8 +/- 0.1] g/cm2), nor in the pain score ([0.6 +/- 0.2] vs [0.7 +/- 0.1], P>0.05).</p><p><b>CONCLUSION</b>MAB treatment (range from 7 to 12 months) has no significant influence on BMD in men with prostate cancer, but BMD should be measured before MAB.</p>

Urologic and reproductive health status of 30 - 60 years old males: investigation among 1006 men in Shijingshan District of Beijing / 中华男科学杂志

<p><b>OBJECTIVE</b>To know and find some evidence for the improvement of the urologic and reproductive health of men between 30 and 60 years old.</p><p><b>METHODS</b>Using stratified random sampling, we conducted a questionnaire investigation on the urologic and reproductive health status of 1 006 men aged from 30 to 60 years old in the Shijingshan District of Beijing, including the unemployed, taxi drivers and office workers.</p><p><b>RESULTS</b>Of the 1006 males investigated, BMI > or = 24 kg/m2 was found in 72.7%, hypertension in 40.0%, abnormal IPSS in 85.5%, abnormal NIH-CPSI in 75.6%, abnormal IIEF-5 in 66.3%, aging male symptoms (AMS) in 10.7%, anxiety in 17.1%, depression in 25.1%, fasting blood-glucose >6.1 mmol/L in 34.9%, total cholesterol >5.07 mmol/L in 44.3% and triglyceride > 1.71 mmol/L in 46.6%; the level of total testosterone was (17.9 +/- 7.2) nmol/L, < 12 nmol/L in 21.3% and <8 nmol/L in 3.4%, and the level of free testosterone was (6.5 +/- 15.1) pmol/L.</p><p><b>CONCLUSION</b>The urologic and reproductive health status of 30 to 60 years old males in Beijing deserves serious attention from medical workers.</p>

Value of laparoscopic virtual reality simulator in laparoscopic suture ability training of catechumen / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the value of laparoscopic virtual reality simulator in laparoscopic suture ability training of catechumen.</p><p><b>METHODS</b>After finishing the virtual reality training of basic laparoscopic skills, 26 catechumen were divided randomly into 2 groups, one group undertook advanced laparoscopic skill (suture technique) training with laparoscopic virtual reality simulator (virtual group), another used laparoscopic box trainer (box group). Using our homemade simulations, before grouping and after training, every trainee performed nephropyeloureterostomy under laparoscopy, the running time, anastomosis quality and proficiency were recorded and assessed.</p><p><b>RESULTS</b>For virtual group, the running time, anastomosis quality and proficiency scores before grouping were (98 ± 11) minutes, 3.20 ± 0.41, 3.47 ± 0.64, respectively, after training were (53 ± 8) minutes, 6.87 ± 0.74, 6.33 ± 0.82, respectively, all the differences were statistically significant (all P < 0.01). In box group, before grouping were (98 ± 10) minutes, 3.17 ± 0.39, 3.42 ± 0.67, respectively, after training were (52 ± 9) minutes, 6.08 ± 0.90, 6.33 ± 0.78, respectively, all the differences also were statistically significant (all P < 0.01). After training, the running time and proficiency scores of virtual group were similar to box group (all P > 0.05), however, anstomosis quality scores in virtual group were higher than in box group (P = 0.02).</p><p><b>CONCLUSION</b>The laparoscopic virtual reality simulator is better than traditional box trainer in advanced laparoscopic suture ability training of catechumen.</p>

Efficacy and safety of bipolar plasma vaporization of the prostate with "button-type" electrode compared with transurethral resection of prostate for benign prostatic hyperplasia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Transurethral resection of prostate (TURP) has been considered as the standard treatment for benign prostatic hyperplasia (BPH). However, issues that have not yet been overcome for TURP include bleeding and absorption of irrigation fluid. Thus, novel improvement of the surgery is necessary. This study aimed to evaluate the efficacy and safety of bipolar plasma vaporization of the prostate (BPVP) with "button-type" electrode against standard TURP for BPH.</p><p><b>METHODS</b>From January 2009 to January 2012, 30 patients who scheduled for surgical treatment of BPH surgical treatment were enrolled in the trial with provided consent for the study. Patients were prospectively randomized 1:1 to undergo either BPVP or TURP. Participants were blinded to the randomization scheme. All cases were assessed preoperatively and followed at 1, 3, and 6 months postoperatively by indwelling catheter time, blood loss, hospital stays, International Prostate Symptom Score (IPSS), quality of life (QOL), and Qmax.</p><p><b>RESULTS</b>BPVP was significantly superior to TURP in terms of indwelling catheter time ((4.1 ± 4.1) days vs. (6.8 ± 6.8) days, P = 0.000), blood loss ((64.7 ± 103.8) ml vs. (254.7 ± 325.4) ml, P = 0.040), hospital stay ((8.7 ± 1.0) days vs. (11.7 ± 1.5) days, P = 0.000), IPSS ((4.2 ± 8.0) vs. (9.3 ± 3.7), P = 0.049), QOL ((1.5 ± 0.8) vs. (2.6 ± 1.4), P = 0.027), Qmax ((16.3 ± 5.7) ml/s vs. (12.5 ± 3.1) ml/s, P = 0.038), hemoglobin ((130.7 ± 9.4) g/L vs. ((122.1 ± 11.9) g/L, P = 0.047), Na(+) level ((138.6 ± 2.1) mmol/L vs. ((137.2 ± 2.0) mmol/L, P = 0.046) and operation time ((39.0 ± 15.5) minutes vs. ((69.3 ± 24.8) minutes, P = 0.004). And there were no statistical differences between BPVP group and TURP group in preoperatively assessment: patient's age ((70.9 ± 7.1) years vs. (71.9 ± 6.1) years, P = 0.736), IPSS ((24.6 ± 4.7) vs. (27.3 ± 5.9), P = 0.100), QOL ((5.1 ± 0.8) vs. (5.1 ± 1.0), P = 0.940), Qmax ((4.4 ± 2.7) ml/s vs. (5.3 ± 2.6) ml/s, P = 0.314), hemoglobin ((137.4 ± 8.7) g/L vs. (139.2 ± 10.4) g/L, P = 0.623), Na(+) level ((140.5 ± 1.8) mmol/L vs. (141.3 ± 1.4) mmol/L, P = 0.192) and prostate volume ((59.0 ± 17.4) ml vs. (70.1 ± 28.8) ml, P = 0.276).</p><p><b>CONCLUSIONS</b>Compared with TURP, BPVP with "button-type" electrode shows superior efficacy and safety. Therefore, BPVP with "button-type" electrode represents a valuable endoscopic treatment alternative for BPH patients.</p>

Face and content validation of the virtual reality transurethral prostatic resection simulator / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the face and content validation of the virtual reality transurethral resection of the prostate simulator (TURPSim(TM)).</p><p><b>METHODS</b>The 60 urology doctor aged 26 - 50 years old all over the country were enrolled for virtual reality training of TURP from September 2010 to June 2011. Participants classified as experts (more than 50 procedures performed) and novices (50 or fewer procedures performed) performed TURPs on TURPSim(TM) involving resection of 25 - 80 g prostate. They completed questionnaires regarding utility for residency training, realism and overall score of the TURPSim(TM). Performances of two groups were evaluated after 2-day training.</p><p><b>RESULTS</b>were recorded and analyzed.</p><p><b>RESULTS</b>Mean utility for residency training, realism and overall score were (8.8 ± 1.1) and (8.5 ± 1.4), (8.0 ± 1.2) and (8.4 ± 1.1), (8.7 ± 0.9) and (8.6 ± 0.8) in experts and novices respectively. There was no significant difference between two groups (P > 0.05). Spearman's correlation coefficients analysis showed an significant positive correlation between utility for residency training and realism (r = 0.625, P = 0.000), utility for residency training and overall score (r = 0.691, P = 0.000) in experts, utility for residency training and realism (r = 0.702, P = 0.000), utility for residency training and overall score (r = 0.664, P = 0.001) in novices. Prostate resection rate (87.3% ± 7.7%), bleeding control rate (94.4% ± 6.6%) and safety (95.2% ± 5.5%) in novices increased after training (t = -3.689, -2.274, -2.507, all P < 0.05).</p><p><b>CONCLUSIONS</b>The face and content validation of transurethral resection of the prostate simulator is good, virtual reality training of TURP may improve the skills necessary to perform TURP. Transurethral resection of the prostate simulator can be used to train urology residents.</p>

Differential expression of hyaluronic acid synthase family in human bladder transitional cell carcinoma and its clinical significance / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the differential expression of the hyaluronic acid synthase (HAS) family in human bladder transitional cell carcinoma (BTCC) and its potential clinical significance.</p><p><b>METHODS</b>The relative quantitative detection of the expression of HAS isoforms (HASs) was performed in 78 human BTCC tissues (mRNA & protein) and 12 normal human bladder mucosa (protein) by real-time RT-PCR and Western blot, and the results were statistically analyzed according to the clinical data.</p><p><b>RESULTS</b>All the BTCC tissues expressed three HAS isoform mRNA and protein, but to a different extent, as for mRNA, HAS3 > HAS2 > HAS1 (P < 0.001), with a significant difference in HAS1/HAS2, HAS1/HAS3 and HAS2/HAS3 (P = 0.003, < 0.001, 0.006, respectively). Among the proteins, the HAS2 expression was the highest, with a significant difference in HAS1/HAS2, and HAS2/HAS3 (P = 0.004, 0.001, respectively), but not in HAS1/HAS3. The elevation of HAS1 mRNA and protein expression was significantly related with the tumor malignancy, tumor initial onset/recurrence, T1/T2 and T1/T3-4 stags, and tumor grading (P = 0.02, < 0.001, 0.038, < 0.001; 0.025, 0.031, 0.023, 0.002; respectively). The HAS2 mRNA expression was significantly related with tumor size (diameter ≤ 3.0 cm/> 3.0 cm), tumor number (single or multiple), tumor initial onset/recurrence, T-staging, and histopathological differentiation (low grade/high grade) (P = 0.012, 0.004, < 0.001, < 0.001, < 0.001, respectively), but its protein expression was not significantly different in all subgroups except with the tumor size (mass diameter > 3.0 cm/≤ 3.0 cm). However, HAS3 mRNA and protein expression had no significant difference among all the subgroups. In normal human bladder mucosa, no HAS expressions were detected.</p><p><b>CONCLUSIONS</b>The abnormally high expression of the HASs further indicate the reliability of hyaluronan as a urinary marker for human BTCC. Compared with HAS1 and HAS3, HAS2 as a marker may have more usefulness in studies on human BTCC carcinogenesis or development. The high expression of HAS1 protein seems to play a more important role in the BTCC tumorigenesis, and may indicate a poor prognosis of the BTCC patients.</p>

Association of the serum testosterone level with metabolic syndrome in men / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the association of the serum testosterone (T) level with metabolic syndrome (MS).</p><p><b>METHODS</b>We enrolled in this investigation 1,006 men aged 30-60 years in Beijing and obtained the data on their blood pressure (BP), waist circumference (WC), fasting blood glucose (FBG), serum triglycerides (TG), high density lipoprotein-cholesterol (HDL-C) and serum testosterone (T). The men were divided into an MS group and a non-MS (NMS) group based on The Chinese Adult Dyslipidemia Prevention Guide 2007. The results were compared and analyzed.</p><p><b>RESULTS</b>There was no statistically significant difference between the ages of the two groups (P >0.05). Systolic BP (SBP), diastolic BP (DBP), WC, FBG and TG were significantly higher, while serum T and HDL-C remarkably lower in the MS than in the NMS group (P <0.001). The serum T level was markedly decreased with the increase of MS components (P <0.01). Both Pearson's correlation coefficients and multiple linear regression analyses showed that the serum T level was negatively correlated with age, WC, SBP and TG (P < 0.05).</p><p><b>CONCLUSION</b>Low serum T level may predict the development of MS in men.</p>

Prevalence of overactive bladder in a community-based male aging population / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the situation of overactive bladder (OAB) in a community-based male population.</p><p><b>METHODS</b>Male participants over 50 years old were randomly selected from multiple communities in Beijing. The evaluation of lower urinary tract symptoms (LUTS) including the International Prostate Symptom Score (IPSS), quality of life (QOL) score, prostate volume and post voiding residue (PVR) by abdominal ultrasonography, and maximum flow rate (Qmax). Definition of OAB was determined as the score of item number 4 in IPSS ≥ 2.</p><p><b>RESULTS</b>Of 1656 male participants enrolled, a total of 1639 men met our study criteria. The mean age was (64 ± 10) years. The prevalence of OAB was 26.3% (431/1639), and was significantly related to age, IPSS, QOL score, prostate volume, PVR and Qmax (P < 0.01). The prevalence of OAB was closely associated with aging (P < 0.01) and the degree of LUTS (P < 0.01).</p><p><b>CONCLUSIONS</b>The prevalence of OAB increased with aging of the community-based male population. OAB would obviously affect the quality of life of the aging men.</p>

Analysis and clinical implication of upper urinary tract stone's bacterial spectrum / 中华外科杂志

<p><b>OBJECTIVES</b>To analyze the pathogenic bacterial's distribution and the drug resistance in the upper urinary tract stones, and to provide the information for choosing suitable antibiotics.</p><p><b>METHODS</b>Stone samples were taken for culture and for drug sensitivity test in 146 patients undergoing percutaneous nephrolithotomy between April 2007 and October 2008, and the results were analyzed.</p><p><b>RESULTS</b>Pathogens presented in 72 (49.3%) patients. There were 70 (86.4%) Gram-negative bacteria strains. Escherichia coli, Pseudomonas aeruginosa and Enterobacter cloacae were the predominant bacteria, accounted for 30.9%(25 strains), 23.5% (19 strains) and 12.3% (10 strains), respectively. There were 10 (12.3%) Gram-positive bacteria strains, the predominant bacteria was Staphylococcus epidermidis (6 strains), accounting for 7.4%. And there was 1 fungi strain (1.2%). Resistance to ampicillin/sulbactam (88.7%), ceftriaxone (81.3%) and ciprofloxacin (67.5%) was most commonly found in pathogen, and the rate of resistance to amikacin, imipenem and piperacillin/tazobactam were 8.6%, 10.0%, 10.0%, respectively. Erythromycylamine, teicoplanin, SMZ-TMP, nitrofurantoin were sensitive to Gram-positive bacteria.</p><p><b>CONCLUSIONS</b>Bacterial's distribution of upper urinary tract stones are multiple, and the majority pathogen is Gram-negative bacteria. A big variant resistance is found among different bacterium. The suitable antibiotics should be chosen according to the different bacterium in the patients who underwent percutaneous nephrolithotomy.</p>

Value of abdominal ultrasound scan, CT and MRI for diagnosing inferior vena cava tumour thrombus in renal cell carcinoma / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>We used abdominal ultrasound scan (USS), computed tomography (CT) and magnetic resonance imaging (MRI) findings in venous spread of renal cell carcinoma (RCC) to determine the superior extent of inferior vena cava (IVC) thrombus and IVC wall invasion and compared them with surgical and pathological reports.</p><p><b>METHODS</b>From January 1999 to August 2007, 25 patients were diagnosed with RCC with IVC tumour thrombus. Before their operation, all patients had USS, contrast enhanced CT and MRI to find the superior extent of tumour thrombus and IVC wall invasion. All postprocessing techniques were performed by experienced radiologists. Two pathologists reported on all pathology specimens. The superior extent of tumour thrombus was confirmed by the senior surgeon at each operation, using the levels of thrombus defined according to 2004 Mayo Clinic classification. The radiographic results were compared with surgical and pathological findings.</p><p><b>RESULTS</b>All patients had radical nephrectomy and tumour thrombus excision. Eight patients had RCC on the left side and 17 on the right side. According to the clinical and pathological findings, 6 patients had level I tumour thrombus, 9 level II, 5 level III and 5 level IV. Six patients had IVC wall invasion. No patient had evidence of lymph node or distant metastases. Of the 25 patients, USS correctly diagnosed the superior extent of tumour thrombus in 18/25, CT 23/25 and MRI 23/25. USS found 1 case of IVC wall invasion preoperatively.</p><p><b>CONCLUSIONS</b>Multidetector computed tomography and magnetic resonance imaging are comparable and more effective than abdominal ultrasound in diagnosing inferior vena cava tumour thrombus in renal cell carcinoma. None of the three methods can detect inferior vena cava wall invasion.</p>

Correlation of lower urinary tract symptoms with erectile dysfunction in men aged 50 years and above / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the incidence of lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) in men aged > or = 50 years and to achieve the correlation between LUTS (obstructive symptoms and stimulant symptoms) and ED.</p><p><b>METHODS</b>We investigated 245 men aged > or = 50 years and with regular sex mates using International Prostate Symptom Score (IPSS) and International Index of Erectile Function-5 (IIEF-5), designed diagnostic interrogation and medical examination, and statistically analyzed the results of IPSS, IIEF-5, LUTS and their correlation with erectile function.</p><p><b>RESULTS</b>The incidence of ED was 81.9% (140/171) among the men with LUTS, 73.1% (38/52), 82.1% (46/56) and 88.9% (56/63) respectively in the 50-59, 60-69 and > or = 70 age groups, with significant differences in IPSS, IIEF-5 (P < 0.01) and the severity of ED (P < 0.01) among different age groups. ED incidence was found significantly correlated with the severity of LUTS (r = 0.52, P < 0.01), 71.3% (57/80), 89.6% (60/67) and 95.8% (23/24) respectively in the groups of mild, moderate and severe LUTS. The mean scores on obstructive and stimulant symptoms were (3.1 +/- 3.6) and (6.8 +/- 4.9), and their correlation coefficients with IIEF-5 were r = -0.41 (P < 0.01) and r = -0.59 (P < 0.01), respectively.</p><p><b>CONCLUSION</b>The incidence of ED is high in men with LUTS and positively correlated with the severity of LUTS. Stimulant symptoms have greater influence than obstructive symptoms on the sexual life of old and middle-aged males.</p>

Efficacy and safety of long-acting gonadotropin-releasing hormone analogue in the treatment for metastatic prostate cancer / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of gonadotropin-releasing hormone analogue (GnRHa) triptorelin 11.25 mg 3-month sustained release formulations in the treatment of metastatic prostate cancer.</p><p><b>METHODS</b>From January 2004 to March 2006, a randomized, parallel-controlled, multicenter clinical trial was conducted. One hundred and twenty-seven patients with documented metastatic prostate cancer were randomized to receive one injection of the 11.25 mg formulation triptorelin (n = 65) or three injections at 28-day intervals of the 3.75 mg formulation (n = 62). Changes from baseline of TPSA, prostate volume, testosterone, LH, FSH, PRL and estradiol were assessed over 3 months. Changes of the metastatic lesions were also observed and evaluated. The occurrences of adverse events were evaluated as well.</p><p><b>RESULTS</b>After 3 months treatment, total PSA level decreased significantly from baseline both in 11.25 mg group and 3.75 mg group. At 30, 60 and 90 days, TPSA (median level) declined from 164.55 microg/L into 11.34, 4.12, 3.89 microg/L in 11.25 mg group, and from 101.38 microg/L into 6.88, 2.41, 2.57 microg/L in control group respectively. The patients ratio with over 90% decreasing from TPSA baseline were 78.6% and 75.5% respectively in two groups (P = 0.700). Prostate volume were also decreased significantly in both groups, median volume declined from 48.0 mm(3) into 21.5 mm(3) in 11.25 mg group and from 45.0 mm(3) into 21.0 mm(3) in 3.75 mg group. No significant differences were found between the two groups in changes of TPSA (P = 0.601) and prostate volume (P > 0.05). Both formulations were able to induce castration levels, 0.31 microg/L in 11.25 mg group and 0.26 microg/L in 3.75 mg group (P > 0.05). 13.8% and 17.7% of adverse events were recorded respectively in two groups, and no differences were found (P = 0.547).</p><p><b>CONCLUSION</b>As a new long-acting sustained release formulation, triptorelin 11.25 mg is comparable to triptorelin 3.75 mg formulation in the aspect of efficacy and safety for the treatments of metastatic prostate cancer.</p>