[Diagnosis and treatment of rectal injury during laparoscopic radical prostatectomy: Analysis of 7 cases].

OBJECTIVE: To explore the risk factors and management principles of rectal injury during laparoscopic radical prostatectomy (LRP). METHODS: We retrospectively analyzed the clinical data on 7 cases of LRP complicated with rectal injury and treated in Huzhou Central Hospital from January 2010 to June 2021. Four of the 7 PCa patients were found with complete rectal rupture during LRP, of whom 2 were treated by laparoscopic rectal repair (LRR) and the other 2 by LRR + colostomy during surgery. Another case of rectal muscle injury also underwent LRR. Two cases of delayed rectal rupture were observed postoperatively and treated by colostomy + transrectal repair in the second-stage operation. RESULTS: The rectal injuries were found in the apex of the prostate in all the 7 cases, pathologically staged as pT2b��pT3b and with Gleason scores of 7��10. Postoperative follow-up lasted 2 to 18 months, during which the 5 cases of intraoperative rectal repair recovered well without complications, and of the 2 cases of postoperative rectal repair, 1 made a good recovery and the other 1 developed rectourethral fistula. CONCLUSION: Rectal injury during radical prostatectomy tends to occur in the apex of the prostate and can be effectively managed by laparoscopic repair. Meanwhile, attention should be paid to the postoperative complication of rectourethral fistula.

[Knot-free suture and frenulum positioning combined with application positioning using a disposable circumcision suture device in circumcision].

OBJECTIVE: To explore the effect of knot-free suture and frenulum positioning combined with application positioning (KFS-FP + AP) in circumcision using a disposable circumcision suture device. METHODS: We retrospectively analyzed the clinical data on 160 cases of circumcision for phimosis or redundant prepuce by KFS-FP + AP (the observation group, n = 80) or by routine circumcision (the control group, n = 80) with a disposable circumcision suture device from February 2021 to December 2021. We recorded the operation time, incidence of frenulum breve, incidence of frenulum dislocation, and Visual Analog Scale (VAS) scores at 6 hours after surgery, and compared them between the two groups of patients. RESULTS: The operation time was longer in the observation than in the control group (8.00 ï¼»8.00, 9.00ï¼½ min vs 5.00 ï¼»5.00, 5.00ï¼½ min), and the incidence rates of frenulum breve (0 vs 8.75%, P < 0.05) and frenulum dislocation (0 vs 7.5%, P < 0.05) significantly lower in the former than in the latter group. There were no statistically significant difference in the VAS scores between the observation and the control groups (2.60 ï¼»2.00, 3.00ï¼½ vs 2.55 ï¼»2.00, 3.00ï¼½, P > 0.05). CONCLUSION: KFS-FP + AP with a disposable circumcision suture device is a safe and effective method of circumcision, with high satisfaction of the patients and worthy of clinical promotion.

[Abnormally short frenulum induced by circumcision with the disposable circumcision suture device: Causes and improvement of the surgical method].

OBJECTIVE: To investigate the causes of abnormally short frenulum induced by circumcision with disposable circumcision suture device and the improvement of the surgical method. METHODS: We retrospectively analyzed the clinical data on 320 cases of phimosis or redundant prepuce treated from January 2020 to September 2020, including 160 children (group A) and 160 adults (group B), each further divided into an observation group (n = 80, groups A1 and B1) and a control group (n = 80, groups A2 and B2). The patients in groups A1 and B1 underwent circumcision by suture positioning at the frenulum with the disposable circumcision suture device, and those in groups A2 and B2 received conventional circumcision with the disposable circumcision suture device. We compared the operation time, incidence rate of abnormally short frenulum and Visual Analogue Scale (VAS) score at 6 hours after surgery among the four groups of patients. RESULTS: Statistically significant differences were observed between groups A1 and A2 in the operation time (12.00 ï¼»11.00, 13.00ï¼½ vs 8.50 ï¼»8.50, 9.00ï¼½ min, P < 0.05) and the incidence rate of abnormally short frenulum (0 vs 10%, P < 0.05) but not in the VAS score (3.00 ï¼»3.00, 4.00ï¼½ vs 3.00 ï¼»3.00, 3.75ï¼½, P > 0.05). Statistically significant differences were also found between groups B1 and B2 in the operation time (12.00 ï¼»11.00, 12.00ï¼½ vs 6.25 ï¼»6.00, 7.00ï¼½ min, P < 0.05) and the incidence rate of abnormally short frenulum (0 vs 7.5%, P < 0.05) but not in the VAS score (2.00 ï¼»2.00, 3.00ï¼½ vs 2.00 ï¼»2.00, 3.00ï¼½, P > 0.05). CONCLUSIONS: Abnormally short frenulum induced by circumcision with the disposable circumcision suture device is mainly attributed to ligation and fixation of the prepuce with the fixation band. Circumcision with the disposable circumcision suture device by suture positioning at the frenulum is a safe and effective method worthy of clinical promotion.

[Prostate sarcoma: A retrospective analysis of 26 cases].

OBJECTIVE: To present our experience in the diagnosis and treatment of prostate sarcoma and the clinical and prognostic features of the malignancy. METHODS: We retrospectively analyzed the clinical data on 26 cases of prostate sarcoma treated in our hospital from June 1998 to March 2018. The patients ranged in age from 15 to 64 years (ï¼»41 ± 14ï¼½ yr) and in the PSA level from 0.345 to 5.213 µg/L (ï¼»1.762 ± 1.184ï¼½ µg/L), all diagnosed with prostate sarcoma by prostatic biopsy and pathological examination after transurethral resection of the prostate (TURP). RESULTS: Postoperative pathological examination showed 11 cases of leiomyosarcoma, 6 cases of rhabdomyosarcoma, 4 cases of spindle cell sarcoma, 4 cases of fibrosarcoma and 1 case of undifferentiated sarcoma among the total number of patients. Twenty-four of the patients were followed up for 3 to 18 (mean 13) months, of whom 21 died within 12 months and the other 3 within 13－18 months after diagnosis, all due to extensive metastases. CONCLUSIONS: Prostate sarcoma is a rare malignancy clinically, highly aggressive and with very poor prognosis. Surgery remains the main treatment option, but multiple disciplinary diagnosis and treatment could probably achieve a better prognosis for prostate sarcoma.