Efficacy of brachytherapy versus radical prostatectomy for localized prostate cancer-propensity score-matched comparison.

OBJECTIVE: The brachytherapy (BT) and radical prostatectomy (RP) are two methods recommended in current guidelines for the treatment of localized prostate cancer (PCa). It is difficult to compare the oncological results of these two treatments because of differences in baseline characteristics and treatment selection.we sought to compare the efficacy of BT and RP after propensity score matching(PSM)analysis. METHODS: Between January 2009 and December 2021, our institution treated 657 patients with localized PCa (BT: n = 198; RP: n = 459)and followed up for > 2 years. Biochemical recurrence was defined as prostate-specific antigen (PSA) levels of nadir plus 2 ng/ml or higher (Phoenix definition) for BT, and as PSA0.2 ng/ml or greater for RP. PSM was applied based on the age, body mass index, PSA, prostate volume, clinical T-stage, Gleason grade, percentage of positive puncture needles ≥ 1/2, maximum tumor diameter ≥ 5 mm, and follow-up period. RESULTS: Median follow-up was 63 months for BT and 52 months for RP. After propensity score adjustment, a total of 294 (147 each) patients remained for further analysis.Kaplan-Meier curves showed no statistically significant difference in clinical relapse-free survivals (cRFS) (p = 0.637),overall survival (OS) (p = 0.726),and cancer-specific survival (CSS) (p = 0.505).BT was associated with improved biochemical relapse-free survivals (bRFS) compared to RP (p = 0.022), Logistic multivariate analysis based on the whole cohort revealed that clinical T stage ≥ T2b (p = 0.043) and tumor maximum diameter ≥ 5 mm (p = 0.044) were associated with significantly bRFS. CONCLUSION: The BT and RP group patients exhibited similar cRFS, OS, and CSS. However, patients in the BT groups exhibited better bRFS than those in the RP group.Clinical T stage ≥ T2b and a maximum tumor diameter ≥ 5 mm were independent prognostic factors.

Importance of biopsy sample length for cancer diagnosis during trans-perineal prostate biopsy.

OBJECTIVE: To identify the factors that determine the minimum length of biopsy sample required for accurate diagnosis. MATERIALS AND METHODS: A retrospective analysis was conducted on 1202 cases that underwent rectal ultrasound-guided trans-perineal prostate biopsy (TPB) with standardized biopsy surgical procedures and pathological evaluation. Logistic regression correlation analysis and the imbalance between groups was eliminated by propensity score matching of patients' own factors between groups (positive group and negative group). ROC curve optimal threshold analysis were performed to identify the independent factors associated with cancer detection rate and the minimum length of biopsy sample required for accurate diagnosis. RESULTS: The study included 1202 cases that underwent standardized 8-18 needle initial puncture biopsies from June 2020 to October 2023. The cancer detection rate was 40.02% (481/1202), with Gleason scores of 6, 7, 8, 9, and 10 in 164, 134, 107, 67, and 9 patients, respectively. The percentage of patients with clinical significance (International Society of Urological Pathology (ISUP) ≥ 2) was 65.90% (317/481). Multivariate analysis showed that age,prostate-specific antigen(PSA), prostate volume,positive multi-parametric magnetic resonance imaging (mp-MRI) and length of biopsy samples were significant factors (P < 0.05)。Interestingly, biopsy sample length did not correlate with the prostate volume (Pearson correlation P = 0.069). ROC curve analysis: The area under the curve AUC for sample length were 0.674 and 0.664 at before and after propensity score matching,respectively; the optimal thresholds were 12.25 mm and 11.00mm at before and after propensity score matching,respectively. CONCLUSION: The independent predictors of cancer detection rate during TPB are age, PSA, prostate volume, positive mp-MRI, and sample length. Among these, sample length is the most critical indicator affecting puncture quality, and the minimum value of biopsy sample length to be obtained is 11.00mm.

Lycorine relieves the CCl4-induced liver fibrosis mainly via the JAK2/STAT3 and PI3K/AKT signaling pathways.

Liver fibrosis, a progressive process of fibrous scarring, results from the accumulation of extracellular matrix proteins (ECM). If left untreated, it often progresses to diseases such as cirrhosis and hepatocellular carcinoma. Lycorine, a natural alkaloid derived from medicinal plants, has shown diverse bioactivities by targeting JAK2/STAT3 signaling, but its pharmacological effects and potential molecular mechanisms in liver fibrosis remains largely unexplored. The purpose of this study is to elucidate the pharmacological activity and molecular mechanism of lycorine in anti-hepatic fibrosis. Findings indicate that lycorine significantly inhibited hepatic stellate cells (HSCs) activation by reducing the expression of α-SMA and collagen-1. In vivo, lycorine treatment alleviated carbon tetrachloride (CCl4) -induced mice liver fibrosis, improving liver function, decreasing ECM deposition, and inhibiting fibrosis-related markers' expression. Mechanistically, it was found that lycorine exerts protective activity through the JAK2/STAT3 and PI3K/AKT signaling pathways, as evidenced by transcriptome sequencing technology and small molecule inhibitors. These results underscore lycorine's potential as a therapeutic drug for liver fibrosis.

Effects of Varicocele Surgical Repair on Serum Hormone and Inhibin B Levels for Patients With Varicocele: A Systematic Review and Meta-Analysis.

Varicocele surgical repair can improve the function of the testis for patients with varicocele. We carried out a systematic review and meta-analysis to assess the effects of varicocele surgical repair on serum hormones and inhibin B levels in patients with varicocele. A literature search was performed in August 2022, and no language or geographic region restrictions were applied. The search included the following databases: PubMed, Embase, and Medline. A literature review was performed to identify all published clinical trials assessing serum hormone and inhibin B levels before and after varicocele surgical repair. The reference lists of retrieved studies were also investigated. A systematic review and meta-analysis were conducted. Eight articles were selected from 162 articles, including 452 patients. The combined analysis showed that after surgical treatment, mean serum testosterone, inhibin B, and sperm concentration levels increased compared with preoperative levels (p < .05). After surgical treatment, mean serum follicle-stimulating hormon (FSH), and Luteinizing hormone (LH) levels decreased compared with preoperative levels (p < .05). This meta-analysis demonstrates that varicocele surgical repair can improve testicular function, increase serum testosterone, and inhibin B levels and decrease serum FSH and LH levels in patients with varicocele. This might be related to the improvement of infertility. A large-scale multicenter randomized controlled study is needed for further confirmation.

Harmonic Vibrational Frequency Simulation of Pharmaceutical Molecules via a Novel Multi-Molecular Fragment Interception Method.

By means of a computational method based on Density Functional Theory (DFT), using commercially available software, a novel method for simulating equilibrium geometry harmonic vibrational frequencies is proposed. Finasteride, Lamivudine, and Repaglinide were selected as model molecules to study the adaptability of the new method. Three molecular models, namely the single-molecular, central-molecular, and multi-molecular fragment models, were constructed and calculated by Generalized Gradient Approximations (GGAs) with the PBE functional via the Material Studio 8.0 program. Theoretical vibrational frequencies were assigned and compared to the corresponding experimental data. The results indicated that the traditional single-molecular calculation and scaled spectra with scale factor exhibited the worst similarity for all three pharmaceutical molecules among the three models. Furthermore, the central-molecular model with a configuration closer to the empirical structure resulted in a reduction of mean absolute error (MAE) and root mean squared error (RMSE) in all three pharmaceutics, including the hydrogen-bonded functional groups. However, the improvement in computational accuracy for different drug molecules using the central-molecular model for vibrational frequency calculation was unstable. Whereas, the new multi-molecular fragment interception method showed the best agreement with experimental results, exhibiting MAE and RMSE values of 8.21 cm-1 and 18.35 cm-1 for Finasteride, 15.95 cm-1 and 26.46 cm-1 for Lamivudine, and 12.10 cm-1 and 25.82 cm-1 for Repaglinide. Additionally, this work provides comprehensive vibrational frequency calculations and assignments for Finasteride, Lamivudine, and Repaglinide, which have never been thoroughly investigated in previous research.

The impact of Helicobacter pylori infection on low skeletal muscle mass risk in Chinese women over 40: a cross-sectional analysis.

Background: Sarcopenia can lead to significant personal, social, and economic burdens. The diagnosis of sarcopenia heavily relies on the identification of Low Skeletal Muscle Mass (LSMM), which is an independent predictor of frailty, disability, and increased risk of death among seniors. Women have physiologically lower levels of skeletal muscle mass than men, and female sarcopenia appears to be more influenced by menopause. They also tend to have higher body fat levels than man, which increases the risk of sarcopenia obesity. On another front, it's also recognized that humans are largely prone to Helicobacter pylori (H. pylori) infection, with global prevalence rates often surpassing 50%. Nevertheless, the interconnection between H. pylori infection and LSMM remains relatively unexplored. Hence, our study specifically targeted women as the research population and sought to explore several risk factors for LSMM. Additionally, we delved into the potential correlation between LSMM and H. pylori infection in women, hoping to gain insights into potential preventative measures or treatment options that may enhance the quality of life for women affected by sarcopenia. Methods: We conducted a cross-sectional study among women aged over 18 years undergoing physical examination. We performed 13C-urea breath test (UBT) for diagnosis of H. pylori infection and Bioelectrical impedance analysis (BIA) for the assessment of LSMM. Logistic regression models were used to analyze the associations of H. pylori infection with LSMM. Results: This study enrolled 1984 Chinese women who were undergoing health check-ups. A univariate logistic regression analysis did not reveal a direct correlation between H. pylori infection and LSMM among this female population (OR=1.149, 95% CI 0.904-1.459, p=0.257). Yet, upon dividing the participants into age-based subgroups, an evident link was observed between H. pylori infection and LSMM in women aged 40 or above (OR=1.381, 95%CI 1.032-1.848, p= 0.030). After adjusting for variables including Age, BMI, TP, ALK, Cre, this relationship remained statistically relevant (OR=1.514, 95%CI 1.085-2.113, p= 0.015). Conclusions: Women who are over 40 years old and currently infected with H. pylori have an increased risk of developing LSMM. Therefore, timely treatment for H. pylori eradication is recommended for this group of women to reduce the occurrence of LSMM.

Indications for nerve-sparing surgery for radical prostatectomy: Results from a single-center study.

Purpose: To explore the clinical indications of using the nerve-sparing technique in radical prostatectomy. Patients and methods: We retrospectively analyzed the clinical and pathological data of 101 patients who underwent radical prostatectomy (RP) at our institution. Twenty-five patients underwent open surgery, and 76 patients underwent laparoscopic surgery. The biochemical recurrence (BCR) rate was analyzed by the method of Kaplan-Meier. The distance between the ipsilateral neurovascular bundles (NVBs) and foci of prostate tumor (N-T distance) was measured in postoperative specimens. We defined the N-T distance >2 mm as the threshold to perform nerve-sparing (NS) in RP. Through logistic regression analysis, we determined the preoperative clinical indications for the nerve-sparing technique in RP. Results: The average BCR-free survival time was 53.2 months in these 101 patients with RP, with the 3- and 5-year BCR-free rates being 87.9% and 85.8%, respectively. The N-T distance was measured in 184 prostate sides from postoperative specimens of 101 patients. Univariate analysis showed that the percent of side-specific biopsy cores with cancer (≥1/3), maximum tumor length in biopsy core (≥5 mm), average percent involvement of each positive core (≥50%), PI-RADS score, and prostate MP-MRI imaging (extra-capsular extension) were associated with the N-T distance (p < 0.003). Furthermore, the percent of side-specific biopsy cores with cancer (≥1/3) (OR = 4.11, p = 0.0047) and prostate MP-MRI imaging (extra-capsular extension) (OR = 3.92, p = 0.0061) were found to be statistically significant independent predictors of the N-T distance in multivariate analysis. Conclusions: The clinical indications of nerve-sparing RP were <1/3 side-specific biopsy cores with cancer and no extra-capsular extension by prostate MP-MRI examination.

Neoadjuvant and Adjuvant Chemotherapy for Variant Histology Bladder Cancers: A Systematic Review and Meta-Analysis.

Context: To improve the prognosis of variant histology (VH) bladder cancers, clinicians have used neoadjuvant chemotherapy (NAC) or adjuvant chemotherapy (AC) on the basis of radical cystectomy (RC). Despite some new data, the evidence remains mixed on their efficacy. Objective: To update the current evidence on the role of NAC and AC for VH bladder cancers. Evidence Acquisition: We searched for all studies investigating NAC or AC for bladder cancer patients with variant histology in PubMed, Embase, and the Cochrane Central Register of Controlled Trials up to December 2021. The primary end points were recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Evidence Synthesis: We identified 18 reports comprising a total of 10,192 patients in the NAC studies. In patients with VH, the use of NAC did improve CSS (hazard ratio [HR] 0.74, 95% confidence interval [CI] 0.55-0.99, p = 0.044), and OS (HR 0.74, 95% CI 0.66-0.84, p = 0.000), but not RFS (HR 1.15, 95% CI 0.56-2.33, p = 0.706). Subgroup analyses demonstrated that receiving NAC was associated with better OS in sarcomatoid VH (HR 0.67, 95% CI 0.54-0.83, p = 0.000) and neuroendocrine VH (HR 0.54, 95% CI 0.43-0.68, p = 0.000). For AC, we identified eight reports comprising a total of 3254 patients. There was a benefit in CSS (HR 0.61, 95% CI 0.43-0.87, p = 0.006) and OS (HR 0.76, 95% CI 0.60-0.98, p = 0.032). Subgroup analyses demonstrated that only neuroendocrine VH had better CSS (HR 0.29, 95% CI 0.13-0.67, p = 0.174) when receiving AC. Conclusions: NAC or AC for VH bladder cancers confers an OS and CSS benefit compared with RC alone. For NAC, the benefit was independently observed in the sarcomatoid and neuroendocrine subgroups. As for AC, only neuroendocrine subgroups improved CSS. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021289487.

Characteristics of ultrafine-ground potassium-bearing shale and the effects of roasting pre-cracking.

Potassium-bearing shale is being developed as a potential alternative to potash for use in fertilisers. The first step in this process is to reduce its particle size by crushing. This paper explores whether roasting pre-cracked potassium-bearing shale can improve the quality of the resulting ultrafine product. Analysis of the particle size distribution of the ultrafine product and its fractal dimension found contradictory results: the minimum particle size distribution was obtained by roasting for 2.5 h, while the minimum fractal dimension was obtained by roasting for 1 h. Fuzzy comprehensive evaluation was conducted with three indicators-(1) the weight of the - 10 µm product, (2) the fractal dimension of the particle size distribution, and (3) d97-to obtain a unique combination of indicators that reflects the quality and quantity of the products. The weights of the three indicators were calculated by an analytic hierarchical process to be 0.69, 0.149 and 0.161, respectively. Roasting pre-cracked shale for 2-2.5 h was found to improve the mean values of the fuzzy comprehensive evaluation indicators by about 0.07. However, the cost increased from 2.82 RMB to ≥ 10.08 RMB, which is not feasible for widespread industrial implementation.

Impact of RET Screening on the Management of Multiple Endocrine Neoplasia Type 2A: 10 Years Experience and Follow-Up in Three Families.

BACKGROUND: Multiple endocrine neoplasia type 2A (MEN 2A) is mainly caused by germline RET codon C634 mutation and is characterized by Medullary Thyroid Carcinoma (MTC), pheochromocytoma (PHEO), and hyperparathyroidism (HPTH). The early diagnosis and initial normative treatment are helpful for the long-term outcome of MEN2A. METHODS: Three index cases and their 29 relatives from three families with MEN2A were included in this study. Genetic screening was performed on all participants. Demographic, clinical profiles, tumor histopathologic features, and follow-up records were systematically analyzed. RESULTS: In total, RET C634Y mutation was identified in 10 individuals (10/32, 31.3%). Among them, 5 presented with MTC symptoms, whereas the other 5 did not show apparent clinical manifestation, and all were subjected to thyroidectomy with varying neck dissection. Compared to individuals in the former, the latter benefited greatly from RET screening with significantly younger age at diagnosis of MTC and surgery (18.1 ± 13.8 years vs. 39.0 ± 14.1 years, P =0.045), and lessaggressive MTC behavior (size: 0.74 vs. 2.82 cm, P =0.026; LN+/resected: 20.0% vs. 100.0%, P =0.048) and also lower recurrence rate of MTC (20.0% vs. 100.0%, P =0.048). The PHEO was identified in 6 of the 10 carriers (60.0%), and all had undergone adrenal-sparing surgery. During the 10 years of follow-up, one (16.7%) developed recurrence of PHEO. CONCLUSION: Integrated RET screening, serum calcitonin, and plasma metanephrine/ normetanephrine levels can facilitate the early diagnosis and standardized MTC/PHEO surgery to improve the prognosis of MEN2A. Laparoscopic adrenal-sparing surgery prior to the bilateral total thyroidectomy is a preferred surgical approach for PHEO.

Selenium-Containing Compound Ameliorates Lipopolysaccharide-Induced Acute Lung Injury via Regulating the MAPK/AP-1 Pathway.

Abstract-Acute lung injury (ALI) is characterized by a series of inflammatory reactions and serves as the main cause of mortality in intensive care unit patients. Although great progress has been made in understanding the pathophysiology of ALI, there are no effective treatments in clinic. Recently, we have synthesized a selenium-containing compound, which possesses obvious anti-inflammatory activity. The aim of the present study is to evaluate the protective effects of the selenium-containing compound 34# in LPS-induced ALI in mice as well as its underlying mechanism. Compound 34# was found to inhibit LPS-induced macrophage inflammatory cytokine release. These effects were observed to be produced via suppression of the MAPK/AP-1 pathway. Compound 34# was also noted to attenuate the LPS-induced lung inflammation in mice with ALI. The corresponding results suggested that compound 34# possesses remarkable protective effects on LPS-induced ALI. Furthermore, the MAPK/AP-1 pathway may prove to be the underlying mechanism. Accordingly, compound 34# may serve as a potential candidate for the prevention of ALI.

Case Report: Paratesticular Rhabdomyosarcoma.

Paratesticular rhabdomyosarcoma (RMS) accounts for only 7% of all the RMS cases. Due to the limited available data, there is no consensus on the diagnosis and management of the paratesticular tumors. Here, we interrogated two paratesticular RMS cases in 25 and 27-year-old men presenting with painless and rapidly growing mass in the scrotum. Whereas the data showed no upregulation of tumor markers such as ß-human chorionic gonadotropin (ß-HCG), alpha-fetoprotein (AFP), and lactate dehydrogenase (LDH), scrotal ultrasonography and magnetic resonance imaging indicated the existence of paratesticular and inguinal lesions respectively. There was local recurrence in one patient who underwent radical orchiectomy for the sarcoma one year ago. In addition, the CT scans showed no occurrence of distant metastasis. The two patients underwent radical inguinal orchiectomy or resection of the recurrent tumors with nerve-sparing retroperitoneal lymph node dissection. Histologic examination revealed embryonal RMS (eRMS) without lymph node metastasis. We highlight the importance of multi-disciplinary participation for paratesticular RMS detection and preoperative ultrasound-guided needle biopsy (UNB) for rapid confirmatory diagnosis. Complete surgical resection coupled with chemotherapy and radiotherapy is the main treatment option for the paratesticular RMS. In addition, sperm cryopreservation treatment and endocrine follow-up could increase the overall survival and quality of life of the patients.

Protective effects of ferroptosis inhibition on high fat diet-induced liver and renal injury in mice.

As a complex and highly prevalent global public health problem, obesity is associated with multiple diseases, including liver and renal injury. As an iron-dependent form of cell death, ferroptosis is different from apoptosis and necrosis, which has been reported to participate in pathologic processes of many diseases. However, whether ferroptosis is involved in obesity-induced liver and renal injury remains unclear. Male C57BL/6 mice were fed with high-fat diet (HFD) or control diet for 16 weeks and treated with 5 mg/kg or 10 mg/kg ferroptosis inhibitor, ferrostatin-1 (Fer-1), for the last 8 weeks with results indicating that glutathione peroxidase 4 (GPX4) gene expression decreased in the liver and renal tissue of obese mice. Additionally, Fer-1 pretreatment prevented the obesity-induced decline of GPX4. More importantly, Fer-1 treatment attenuated HFD-induced pathological and functional impairment, fibrosis, inflammatory cell infiltration, and inflammatory cytokine expression in liver and renal tissues. In short, our results indicate that obesity can induce ferroptosis and ferroptosis inhibitor, Fer-1, thereby inhibiting obesity-induced liver and renal injury in mice. The study provides a new therapeutic direction for the complications of obesity.

Inhibition of MyD88 by LM8 Attenuates Obesity-Induced Cardiac Injury.

Obesity-induced cardiomyopathy involves chronic and sustained inflammation. The toll-like receptor 4 (TLR4) signaling pathway can associate innate immunity with obesity. Myeloid differentiation primary response 88 (MyD88), an indispensable downstream adaptor molecule of TLR4, has been reported to mediate obesity complications. However, whether inhibition of MyD88 can mitigate obesity-induced heart injury remains unclear. LM8, a new MyD88 inhibitor, exhibits prominent anti-inflammatory activity in lipopolysaccharide-treated macrophages. In this study, the protective effects of LM8 on a high-fat diet (HFD)-induced heart injury were assessed in a mouse model of obesity. As suggested from the achieved results, LM8 treatment alleviated HFD-induced pathological and functional damages of the heart in mice. Meantime, the treatment of mice with LM8 could significantly inhibit myocardial hypertrophy, fibrosis, inflammatory cytokines expression, and inflammatory cell infiltration induced by HFD. Besides, LM8 administration inhibited the formation of MyD88/TLR4 complex, phosphorylation of ERK, and activation of nuclear factor-κB induced by HFD. According to the achieved results, MyD88 inhibitor LM8 ameliorated obesity-induced heart injury by inhibiting MyD88-ERK/nuclear factor-κB dependent cardiac inflammatory pathways. Furthermore, targeting MyD88 might be a candidate of a therapeutic method to treat obesity-induced heart injury.

Applied anatomy of pelvic lymph nodes and its clinical significance for prostate cancer:a single-center cadaveric study.

BACKGROUND: Pelvic lymph node dissection (PLND) is one of the most important steps in radical prostatectomy (RP). Not only can PLND provide accurate clinical staging to guide treatment after prostatectomy but PLND can also improve the prognosis of patients by eradicating micro-metastases. However, reports of the number of pelvic lymph nodes have generally come from incomplete dissection during surgery, there is no anatomic study that assesses the number and variability of lymph nodes. Our objective is to assess the utility of adopting the lymph node count as a metric of surgical quality for the extent of lymph node dissection during RP for prostate cancer by conducting a dissection study of pelvic lymph nodes in adult male cadavers. METHODS: All 30 adult male cadavers underwent pelvic lymph node dissection (PLND), and the lymph nodes in each of the 9 dissection zones were enumerated and analyzed. RESULTS: A total of 1267 lymph nodes were obtained. The number of lymph nodes obtained by limited PLND was 4-22 (14.1 ± 4.5), the number obtained by standard PLND was 16-35 (25.9 ± 5.6), the number obtained by extended PLND was 17-44 (30.0 ± 7.0), and the number obtained by super-extended PLDN was 24-60 (42.2 ± 9.7). CONCLUSIONS: There are substantial inter-individual differences in the number of lymph nodes in the pelvic cavity. These results have demonstrated the rationality and feasibility of adopting lymph node count as a surrogate for evaluating the utility of PLND in radical prostatectomy, but these results need to be further explored.

Risk factors associated with the progression of overactive bladder among patients with type 2 diabetes.

AIM: To investigate the risk factors specific to diabetes mellitus that influence the progression of overactive bladder in Chinese population. METHODS: A total of 457 patients who were diagnosed with overactive bladder and diabetes mellitus at the Department of Endocrinology and Urinary Surgery Center of Zhejiang University Jinhua Hospital were enrolled from July 2015 to July 2018. Patients were assessed using a questionnaire and then divided into two groups according to the severity score: mild overactive bladder group and the moderate-severe overactive bladder group. Logistic analysis was performed to evaluate the risk factors associated with the progression of overactive bladder in diabetic patients. RESULT: Among the 457 patients with diabetes mellitus and overactive bladder, there was a significant difference in the severity of overactive bladder, age, diabetes duration, symptomatic diabetic peripheral neuropathy as well as ankle reflex (P < .05) between the two groups. Moreover, multivariate analysis revealed that age (OR: 1.59, P = .036), duration of diabetes (OR: 1.41, P = .049) and symptomatic diabetic peripheral neuropathy (OR: 2.39, P = .012) were independent risk factors for the progression of overactive bladder. CONCLUSION: In Chinese diabetic patients, overactive bladder progression is closely related with the severity of diabetes mellitus. Age, diabetic duration and symptomatic diabetic peripheral neuropathy are independent predictors of the severity of overactive bladder. Patients with symptomatic diabetic peripheral neuropathy are at risk of overactive bladder.

[Effects of performing pelvic lymph node dissection before versus after radical cystectomy].

OBJECTIVE: To explore the efficacies of extended pelvic lymph node dissection (e-PLND) before or after radical cystectomy (RC). METHODS: From January 2003 to January 2013, a total of 107 patients underwent e-PLND plus RC. And their relevant clinical data were reviewed. Their median age was (62 ± 10) years. The e-PLND were divided into 10 regions and 6 groups according to the anatomic sites. Forty-seven (43.9%) underwent RC after e-PLND (group A) and 60 (56.1%) had RC before e-PLND (group B). Two groups were compared for operative duration, numbers of lymph nodes removed, metastatic rates of lymph node, dissected lymph node positive rates and operative complications. The results were analyzed with Chi-square or Student's test. RESULTS: Clinicopathological characteristics were comparable for two groups (P > 0.05). The mean operative durations of e-PLND were similar in both groups ( (83 ± 27) vs (78 ± 24) min , P > 0.05). The mean operative durations of RC were significantly shorter in group A than those in group B ( (79 ± 41) vs (113 ± 44) min, P < 0.01) . The mean number of lymph nodes removed (25.5 ± 9.7 vs 29.0 ± 8.4) and the mean number of lymph nodes removed at internal iliac (5.7 ± 2.9 vs 7.2 ± 3.5) and presacral (1.3 ± 1.1 vs 2.5 ± 1.6) regions were significantly fewer in group A than those in group B (all P < 0.05). The metastatic rates of lymph node (34.0% (16/47) vs 31.7% (19/60)), dissected lymph node positive rates (9.0% (108/1197) vs 7.5% (130/1743)) and operative complications (23.4% (11/47) vs 20.0% (12/60)) were similar in both groups (all P > 0.05). CONCLUSION: RC is performed preferably after e-PLND, and internal iliac and presacral area should be dissected for additional lymph nodes after RC.

[One-stage urethroplasty with circumferential vascular pedicle preputial island flap for perineal hypospadias].

OBJECTIVE: To report the treatment of perineal hypospadias with one-stage urethroplasty with circumferential vascular pedicle preputial island flap. METHODS: A circumferential incision was made proximal to the corona and the urethral plate to correct chordee. A U-shaped skin incision was then made surrounding the meatus, and extended to the dorsal prepuce and parallel to the first incision. The tissue between the prepuce and dartos was dissected on the dorsum of penis to fix the prepuce as a neo urethra. After mobilizing the loop shaped skin flap through the button-hole of the pedicle, the internal and external sides of the loop were sutured to construct a new urethra. The catheter was removed 10-14 days (mean, 12.8 days) after operation. RESULTS: Since 1997, 22 patients with perineal hypospadias were treated. Primary healing was achieved in 18 cases (81.8%). Fistula happened in 4 patients. Among them, one case with meatal stenosis was treated with dilatation. Another 3 patients were reoperated. The neo urethral flap was 3.50-18.00 cm (mean, 9.43 cm) in length. All patients were followed up for more than 6 months. Good cosmetic appearance was achieved in 72.7% (16/22) of the patients. CONCLUSIONS: The circumferential vascular pedicle preputial island flap has advantages of good blood supply and autograft for new meatus, which allows the chordee correction and urethroplasty at one stage. It is a good method for the treatment of perineal hypospadias with severe chordee and penoscrotal transposition.