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.

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>

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>

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>

Changes of urinary symptoms after transurethral resection of the prostate and its correlation with clinical parameters / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the changes of different urinary symptoms of benign prostatic hyperplasia (BPH) patients after transurethral resection of the prostate (TURP) and its correlation with preoperative clinical parameters.</p><p><b>METHODS</b>Two hundred and eighty-one BPH patients were followed-up 3 - 6 months after TURP, whose postoperative International Prostate Symptom Score (IPSS) and Quality of Life (QOL) score were compared with those of preoperation. The relationship between the symptom score changes and clinical data were analyzed. The patients aged (70 +/- 6) years, with preoperative prostate volume (75 +/- 39) ml, T-PSA (5 +/- 5) ng/ml, Qmax (8 +/- 3) ml/s, average tissue weight resected (32 +/- 19) g. Before operation, mean IPSS was 24 +/- 7, QOL 4.6 +/- 1.0, mean obstructive symptom score was 3.6 +/- 1.2, mean irritation symptom score was 3.5 +/- 1.0.</p><p><b>RESULTS</b>After operation mean IPSS was 7 +/- 7 and QOL was 1.2 +/- 1.1, which were significantly decreased. The deduction rate of the mean obstructive symptom score was greater than that of the mean irritative symptom score. Among the 7 urinary symptoms, nocturia and frequency were the two that changed least, with postoperative score of 2.2 +/- 1.1 and 1.2 +/- 1.4 respectively.</p><p><b>CONCLUSIONS</b>Scores of urinary symptoms and QOL of BPH patients were significantly improved after TURP. The improvements of the symptom scores and QOL are correlated to the preoperative scores. There is no correlation between symptom score improvements and patients' age, preoperative prostate volume, T-PSA, Qmax and tissue weight resected. Improvement of average obstructive symptom score is greater than that of irritative symptom score. Among the seven symptoms, nocturia is the one with lowest improvement after TURP.</p>

Comparison of different drugs on the treatment of benign prostate hyperplasia / 中华外科杂志

<p><b>OBJECTIVE</b>To compare the differences of the efficacy and different therapeutic drugs on the treatment of benign prostatic hyperplasia (BPH) in order to ensure the optimal indication for different BPH patients.</p><p><b>METHODS</b>A randomized, parallel-controlled, multicenter clinical trial was conducted. From September 2002 to December 2003 906 BPH patients were enrolled into 7 therapeutic groups, including selective-adrenoceptor antagonist (terazosin, doxazosin tamsulosin and naftopidil), 5 alpha-reductase inhibitor (finasteride and epristeride) and natural product (cernilton). International Prostate Symptom Score (IPSS) and Quality of Life (QOL), uroflowmetry, total prostatic volume (TPV) and transitional zone volume and residual urine were used as efficacy criteria.</p><p><b>RESULTS</b>According to the baseline, the IPSS and Qmax were significantly correlated to the prostatic volume and transitional zone volume (P < 0.01). At average follow-up of 6 months, significant improvements in IPSS, QOL, Qmax and residual urine volume were observed in each therapeutic group, and no difference in IPSS improvement was found among the groups. Prostatic volume and transitional zone volume were significant decreased in 5alpha-reductase inhibitor groups (P < 0.05). In patients with baseline TPV greater than 35.5 cm3, the improvement of Qmax was more significant than that in patients with TPV less than 35.5 cm3 in finasteride group (P < 0.01) (5.7 ml/s and 2.2 ml/s respectively), and more significant symptomatic improvements were also found in cernilton, doxazosin and naftopidil group. In each group, the improvement of symptom were more significant in patients with IPSS higher than 20 points (P < 0.01).</p><p><b>CONCLUSIONS</b>Each drug observed in this study can improve the subjective and objective symptoms significantly for BPH patients, especially for patients with higher IPSS baseline. When using 5alpha-reductase inhibitor, prostatic volume can be decreased significantly and more obviously subjective and objective improvement can be found in the patients with TPV greater than 35.5 cm3.</p>

A clinical study of prostat combined with an antibiotic for chronic nonbacterial prostatitis / 中华男科学杂志

<p><b>OBJECTIVE</b>To evaluate the efficacy and safety of Prostate in combination with an antibiotic for the treatment of chronic nonbacterial prostatitis.</p><p><b>METHODS</b>A double-blind, parallel contrasted, multi-central method was applied in the study. After the Stamey test and expressed prostate secretion (EPS) examination, 160 patients with prostatitis were recruited and randomized into a trial group (80 cases with 1 case missing) and a control group (80 cases). In the trial group, the patients used the levofloxacin and Prostate during the first 4 weeks and Prostate only during the following 4 weeks. In the control group, the patients used the levofloxacin and placebo during the first 4 weeks, and placebo only during the following 4 weeks. Before and 4 and 8 weeks after the treatment, the patients were visited and evaluated by the national institute health-chronic prostatitis symptom index (NIH-CPSI), EPS, and asked about the side.</p><p><b>RESULTS</b>After 4-week and 8-week treatment, the pain index dropped by 3.34 +/- 2.45 and 4.06 +/- 3.03 in the trial group, and effects. 2.28 +/- 2.42 and 3.30 +/- 3.29 in the control; the voiding index dropped by 2.22 +/- 1.79 and 2.77 +/- 2.04 in the trial group, and 1.24 +/- 1.67 and 1.83 +/- 2.25 in the control respectively. There was significant difference between pre-treatment and post-treatment in both the two groups (P < 0.01), while the difference was not significant between 4-week and 8-week post-treatment (P > 0.05). And there was significant difference between the two groups in the pain index and voiding index (P < 0.01), but not in the white blood cell count and lipid in the EPS (P > 0.05). No serious side effects were recorded, and the tolerance to Prostate and placebo showed no significant difference.</p><p><b>CONCLUSION</b>Prostate in combination with an antibiotic can effectively relieve the pain and voiding symptoms and improve the life quality of the patients with nonbacterial prostatitis and well deserves to be recommended in clinical practice.</p>

Clinical study of Eviprostat for the treatment of benign prostatic hyperplasia / 中华男科学杂志

<p><b>OBJECTIVE</b>To study the efficacy and safety of Eviprostat for the treatment of benign prostatic hyperplasia (BPH).</p><p><b>METHODS</b>An open, multicentral clinical trial was conducted in 100 patients with BPH. Patients received a 12-week oral administration of Eviprostat 2 tablets per-time, 3 times a day. The main indexes of efficacy include international prostatic symptom score (IPSS), maximum urinary flow rate (Qmax), residual urine ( Ru) and prostatic volume (V). The additional indexes are quality of life score (QOL) and average urinary flow rate (Qave).</p><p><b>RESULTS</b>After a 12-week therapy, IPSS, QOL score, Qmax and Qave were significantly improved. IPSS was averagely decreased by 5.67 (P < 0.001); QOL score was averagely decreased by 1.44 (P < 0.001); Qmax was averagely increased by 1.70 ml/s (P <0.001); Qave was averagely increased by 1.15 ml/s (P < 0.001); Ru was averagely decreased by 5.07 ml (P = 0.046) , PSA level was averagely decreased by 0.129 microg/L (P < 0.017). The clinical adverse event rate was 1%.</p><p><b>CONCLUSION</b>Eviprostat is a kind of safe, effective and preferable drug for treating BPH. It can improve the subjective symptoms and objective measures of the patients.</p>