Perineal urethrostomy plus secondary urethroplasty for ultralong urethral stricture: clinical outcomes and influence on the patient's quality of life / 中华男科学杂志

<p><b>OBJECTIVE</b>To investigate the outcomes of perineal urethrostomy plus secondary urethroplasty for ultralong urethral stricture and assess its influence on the patient's quality of life.</p><p><b>METHODS</b>We retrospectively analyzed 54 cases of ultralong urethral stricture treated by perineal urethrostomy from 2000 to 2010. The mean age of the patients was 40 years, and the average length of stricture was 6.5 cm. We evaluated the patients'quality of life by questionnaire investigation and the clinical outcomes based on IPSS, Qmax, the necessity of urethral dilation and satisfaction of the patients.</p><p><b>RESULTS</b>The mean Qmax of the 54 patients was (14.0 +/- 4.7) ml/min. Of the 34 cases that underwent secondary urethroplasty, 22 (64.7%) achieved a mean Qmax of (12.0 +/- 3.5) ml/min, 8 (23.5%) needed regular urethral dilatation and 4 (11.8%) received internal urethrotomy because of restenosis. IPSS scores were 5.4 +/- 2.1 and 8.5 +/- 5.8 after perineal urethrostomy and secondary urethroplasty, respectively. Fifty of the total number of patients (92.6%) were satisfied with the results of perineal urethrostomy, and 22 of the 34 (64.7%) with the results of secondary urethroplasty.</p><p><b>CONCLUSION</b>Perineal urethrostomy plus secondary urethroplasty is safe and effective for ultralong urethral stricture, and affects very little the patient's quality of life.</p>

Correlation between activation of L5-S2 spinal cord astrocytes and effect of substance P in chronic prostatitis pain / 中华男科学杂志

<p><b>OBJECTIVE</b>To observe the expressions of the substance P (SP) mRNA and neurokinin-1 receptor (NK-1R) in the posterior horn of the L5 - S2 spinal cord in the rat model of chronic prostatitis pain, and to investigate the changes in the activation of astrocytes and influence of SP on this activation in rat spinal cord astrocytes cultured in vitro.</p><p><b>METHODS</b>The rat model of chronic prostatitis pain was established by injection of complete Freund's adjuvant (CFA) and assessed by the tail flick threshold test, the control rats injected with sodium chloride and all observed at 0, 14 and 28 days. Changes in the expressions of SP mRNA, NK-1R, glial fibrillary acidic protein (GFAP), tumor necrosis factor-alpha (TNF-alpha) and inducible nitric oxide synthase (iNOS) in the posterior horn of the L5 - S2 spinal cord were detected by RT-PCR and Western blot. Rat spinal cord astrocytes were cultured in vitro and divided into a control group, cultured with ITS cell culture fluid, and two experiment groups, with Group 1 stimulated with SP at the concentration of 10(-9) - 10(-6) mol/L for 12 hours followed by determination of the expressions of TNF-alpha, IL-1beta, NO and NOS by ELISA and nitrate reductase and colorimetric methods, and Group 2 at 10(-7) mol/L for 0, 24, 48 and 72 hours followed by detection of the GFAP expression by Western blot.</p><p><b>RESULTS</b>The expressions of SP mRNA, NK-1 R, GFAP, TNF-alpha and iNOS in the posterior horn of the L5 - S2 spinal cord were obviously higher in the rat prostatitis pain models than in the controls, successively higher at 28 than at 14 and 0 d (P < 0.01), and so was the expression of GFAP at 28 than at 14 d in the experiment groups (P < 0.05). SP induced a gradual increase at 10(-7) mol/L in the expression of GFAP in the spinal cord astrocytes at 0 -72 h, significantly different from that of the control group (P < 0.01), and it promoted the excretion of TNF-alpha and IL-1beta and the activity of NO and NOS at 10(-9) - 10(-6) mol/L at 12 h in a concentration-dependent manner, with marked differences between the experiment and control groups (P < 0.01, P < 0.05). But a decreased excretion of IL-1 beta was observed in the 10(-6) mol/L group, though with no significant difference from the control (P > 0.05).</p><p><b>CONCLUSION</b>Chronic prostatitis pain could upregulate the expressions of the excitatory transmitter SP and receptor in the L5 - S2 spinal cord, and result in the activation of astrocytes and increased excretion of proinflammatory cytokines, which may be associated with the persistence and generalization of prostatitis pain.</p>

Morphological study on the role of ICC-like cells in detrusor neuro-modulation of rat urinary bladder / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the role of ICC-like cells in bladder neuromodulation in rat urinary bladder.</p><p><b>METHODS</b>14 SD rats and 1 guinea pig were sacrificed in this study. The ultra structural relationships among interstitial cells, nerves and detrusor smooth muscle cells (DSMCs) of urinary bladder were investigated by transmission electron microscopy (TEM). c-kit immunofluorescence was used to identify ICC-like cells in SD rat urinary bladder and the structural relationship between ICC-like cells and nerve terminals was studied by immunofluorescence (double-label).</p><p><b>RESULTS</b>Gap junction between ICC-like cells and DSMCs was confirmed by TEM. ICC-like cells were very close apposition with nerve terminals under TEM. ICC-like cells were identified to exist in sub-urothelium layer, along the longitude of smooth muscle bundles and among detrusor smooth muscle in SD rat urinary bladder by c-kit immunofluorescence. Double-labeled tissue with c-kit and PGP9.5 antibodies also showed that ICC-like cells were very close apposition with nerve terminals in SD rat bladder.</p><p><b>CONCLUSIONS</b>Morphological study indicated that ICC-like cells in rat urinary bladder may play an important role in detrusor neuromodulation. Further study on function will be helpful for elucidating the mechanism of bladder neuromodulation clearly.</p>

Clinical application of nerve stimulation in obturator nerve block during transurethral resection of the bladder tumor / 中华神经医学杂志

Objective To explore the feasibility and clinical eflfect of nerve stimulation in obturator nerve block during transurethral resection of the bladder tumor(TURBT). Methods Thirty superfcial bladder tumor patients were randomly divided into observation group and control group, with 15 patients in each group.The patients of observation group were punctured and injected under the guidance of nerve stimulator localization,and the ones in control group underwent conventional puncture and injection of drug.Comparison was done between the 2 groups in curative effect,used drug dose and post-operative life quality. Results One patient in observation group and 7 patients in control group had symptom of adductor spasm, and the efficient rates of the 2 groups were 14/15 (93%) and 8/15 (53%), respectively, and the difference has statistical significrdnce (P＜0.05); the drug used dose and anxious score and depression score of control group were higher than those of obsenration group(P＜0.05). Conclusions The nerve stimulator localization for obturator nerve block during TURBT can improve blocking success rate and quality,and it can be extensiVely used in clinic.

Therapeutic effect of sacral nerve stimulation for neurogenic bladder / 中华神经医学杂志

Objective To observe the therapeutic effect of the sacral nerve stimulation (SNS)on the neurogenic bladder. Methods SNS was used to treat 94 patients with neurogenic bladder. The ICI-Q-SF scores, voiding diary (including urinary incontinence times, urinal pad test, urination times,nocturia times and urinary volume) and urine dynamics test (including bladder volume, pressure of detrusor, maximum urinary flow rate, average urinary flow rate, pressure of bladder neck, maximal urethral pressure, functional urethral length and residual urine volume) were observed before and 1 week after SNS. And the data was analyzed statistically. Results The ICI-Q-SF scores were 17.2±1.8 before the treatment of SNS and 8.3±1.6 after SNS (P＜0.05). The urinary incontinence times, urination times and nocturia times were significantly decreased (P＜0.05) compared with those before treatment. The weight of urinal pads was lessened significantly (P＜0.05), while the urinary volumes were increased significantly (P＜0.05). The bladder volume, the maximum urinary flow rate and the average urinary flow rate were increased significantly (P＜0.05) while the residual urine volumes were decreased significantly (P＜0.05). There were no differences in pressure of detrusor, pressure of bladder neck, maximal urethral pressure and functional urethral length (P＞0.05). No complication occurred in our study and total effective rate was 75.5%. Conclusions The therapeutic effect of SNS on the neurogenic bladder is sure, and the symptom of the neurogenic bladder is well improved with few complications. It should be widely used.