Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethra...Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.展开更多
Objectives： We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation （HPBD） technique for anterior ureth...Objectives： We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation （HPBD） technique for anterior urethral stricture Methods： From January 2009 to December 2012, a total of 31 patients with anterior urethral strictures underwent HPBD at our center, while another 25 cases were treated by direct vision internal urethrotomy （DVIU）. Patient de- mographics, stricture characteristics, surgical techniques, and operative outcomes were assessed and compared between the two groups. The Kaplan-Meier survival analysis was applied to evaluate the stricture-free rate for the two surgical techniques. Results： The operation time was much shorter for the HPBD procedure than for the DVIU （（13.19±2.68） min vs. （18.44±3.29） min, P〈0.01）. For the HPBD group, the major postoperative complications as urethral bleeding and urinary tract infection （UTI） were less frequently encountered than those in DVIU （urethral bleeding： 2/31 vs. 8/25, P=0.017; UTI： 1/31 vs. 6/25 P=0.037）. The Kaplan-Meier survival analysis showed that there was no significant difference in stricture-free rate at 36 months between the two groups （P=-0.21, hazard ratio （HR）=0.65, 95% confidence interval （CI）： 0.34 to 1.26）. However, there was a significantly higher stricture-free survival in the HPBD group at 12 months （P=-0.02, HR=0.35, 95% CI： 0.14 to 0.87）, which indicated that the stricture recurrence could be delayed by using the HPBD technique. Conclusions： HPBD was effective and safe and it could be considered as an alternative treatment modality for anterior urethral stricture disease.展开更多
Testicular nuclear receptor 4(TR4),also known as NR2C2(nuclear receptor subfamily 2,group C,member 2),is a transcriptional factor and a member of the nuclear receptor family.TR4 was initially cloned from human and rat...Testicular nuclear receptor 4(TR4),also known as NR2C2(nuclear receptor subfamily 2,group C,member 2),is a transcriptional factor and a member of the nuclear receptor family.TR4 was initially cloned from human and rat hypothalamus,prostate,and testes libraries.For almost two decades,its specific tissue distribution,genomic organization,and chromosomal assignment have been well investigated in humans and animals.However,it has been very difficult to study TR4's physiological functions due to a lack of specific ligands.Gene knock-out animal techniques provide an alternative approach for defining the biological functions of TR4.In vivo studies of TR4 gene knockout mice(TR4-/-) found that they display severe spinal curvature,subfertility,premature aging,and prostate prostatic intraepithelial neoplasia(PIN) development.Upstream modulators,downstream target gene regulation,feedback mechanisms,and differential modulation mediated by the recruitment of other nuclear receptors and coregulators have been identified in studies using the TR4-/-phenotype.With the establishment of a tissue-specific TR4-/-mouse model,research on TR4 will be more convenient in the future.展开更多
Objective： It is recommended that transurethral resection of the prostate （TURP） after brachytherapy should not be performed at an early stage after implantation. Herein we report our experiences and the results of...Objective： It is recommended that transurethral resection of the prostate （TURP） after brachytherapy should not be performed at an early stage after implantation. Herein we report our experiences and the results of channel TURP （cTURP） within six months post-implant for patients with refractory urinary retention. Methods： One hundred and ninety patients with localized prostate cancer of clinical stages Tlc to T2c were treated by brachytherapy as monotherapy at our institution from February 2009 to July 2013. Nine patients who developed refractory urinary retention and underwent cTURP within six months after brachytherapy were retrospectively reviewed and analyzed. Results： The median interval between prostate brachytherapy and cTURP was three months （range 1.5 to 5.0 months） There were no intraoperative or postoperative complications and no incontinence resulting from the surgery. All urinary retention was relieved per the American Brachytherapy Society urinary symptom score. With a mean follow-up time of 16 months （range 6 to 26 months） after cTURP, no patient experienced biochemical recurrence. The mean serum prostate-specific antigen （PSA） of the patients who underwent cTURP was 0.42 ng/ml （range 0.08 to 0.83 ng/ml） at the end of their follow-up. Conclusions： Early cTURP was found to be safe and effective in relieving urinary retention after brachytherapy and could be performed without compromising its therapeutic efficacy.展开更多
基金the National Key Research and Development Plan of China(Technology helps Economy 20202016YFC0106300)+1 种基金the National Natural Science Foundation of China(82174230)Major Program Fund of Technical Innovation Project of Department of Science and Technology of Hubei Province(2016ACAl52).
文摘Benign prostatic hyperplasia (BPH) is highly prevalent among older men, impacting on their quality of life, sexual function, and genitourinary health, and has become an important global burden of disease. Transurethral plasmakinetic resection of prostate (TUPKP) is one of the foremost surgical procedures for the treatment of BPH. It has become well established in clinical practice with good efficacy and safety. In 2018, we issued the guideline “2018 Standard Edition”. However much new direct evidence has now emerged and this may change some of previous recommendations. The time is ripe to develop new evidence-based guidelines, so we formed a working group of clinical experts and methodologists. The steering group members posed 31 questions relevant to the management of TUPKP for BPH covering the following areas: questions relevant to the perioperative period (preoperative, intraoperative, and postoperative) of TUPKP in the treatment of BPH, postoperative complications and the level of surgeons’ surgical skill. We searched the literature for direct evidence on the management of TUPKP for BPH, and assessed its certainty generated recommendations using the grade criteria by the European Association of Urology. Recommendations were either strong or weak, or in the form of an ungraded consensus-based statement. Finally, we issued 36 statements. Among them, 23 carried strong recommendations, and 13 carried weak recommendations for the stated procedure. They covered questions relevant to the aforementioned three areas. The preoperative period for TUPKP in the treatment of BPH included indications and contraindications for TUPKP, precautions for preoperative preparation in patients with renal impairment and urinary tract infection due to urinary retention, and preoperative prophylactic use of antibiotics. Questions relevant to the intraoperative period incorporated surgical operation techniques and prevention and management of bladder explosion. The application to different populations incorporating the efficacy and safety of TUPKP in the treatment of normal volume (< 80 ml) and large-volume (≥ 80 ml) BPH compared with transurethral urethral resection prostate, transurethral plasmakinetic enucleation of prostate and open prostatectomy;the efficacy and safety of TUPKP in high-risk populations and among people taking anticoagulant (antithrombotic) drugs. Questions relevant to the postoperative period incorporated the time and speed of flushing, the time indwelling catheters are needed, principles of postoperative therapeutic use of antibiotics, follow-up time and follow-up content. Questions related to complications incorporated types of complications and their incidence, postoperative leukocyturia, the treatment measures for the perforation and extravasation of the capsule, transurethral resection syndrome, postoperative bleeding, urinary catheter blockage, bladder spasm, overactive bladder, urinary incontinence, urethral stricture, rectal injury during surgery, postoperative erectile dysfunction and retrograde ejaculation. Final questions were related to surgeons’ skills when performing TUPKP for the treatment of BPH. We hope these recommendations can help support healthcare workers caring for patients having TUPKP for the treatment of BPH.
基金Project supported by the Medical Health Program of Zhejiang Province(No.2014ZDA011)the Zhejiang Provincial Natural Science Foundation of China(No.2015KYB222)
文摘Objectives： We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure balloon dilation （HPBD） technique for anterior urethral stricture Methods： From January 2009 to December 2012, a total of 31 patients with anterior urethral strictures underwent HPBD at our center, while another 25 cases were treated by direct vision internal urethrotomy （DVIU）. Patient de- mographics, stricture characteristics, surgical techniques, and operative outcomes were assessed and compared between the two groups. The Kaplan-Meier survival analysis was applied to evaluate the stricture-free rate for the two surgical techniques. Results： The operation time was much shorter for the HPBD procedure than for the DVIU （（13.19±2.68） min vs. （18.44±3.29） min, P〈0.01）. For the HPBD group, the major postoperative complications as urethral bleeding and urinary tract infection （UTI） were less frequently encountered than those in DVIU （urethral bleeding： 2/31 vs. 8/25, P=0.017; UTI： 1/31 vs. 6/25 P=0.037）. The Kaplan-Meier survival analysis showed that there was no significant difference in stricture-free rate at 36 months between the two groups （P=-0.21, hazard ratio （HR）=0.65, 95% confidence interval （CI）： 0.34 to 1.26）. However, there was a significantly higher stricture-free survival in the HPBD group at 12 months （P=-0.02, HR=0.35, 95% CI： 0.14 to 0.87）, which indicated that the stricture recurrence could be delayed by using the HPBD technique. Conclusions： HPBD was effective and safe and it could be considered as an alternative treatment modality for anterior urethral stricture disease.
基金supported by the National Natural Science Foundation of China (No.30973001)the National Basic Research Program (973) of China (No.2012CB518304)+2 种基金the Zhejiang Provincial Natural Science Foundation of China (No.Y2110446)the Qianjiang Talents Project of Zhejiang Province (No.2011R10039)the PAO Yu-kong International Foundation for Scholars and Scientists,China
文摘Testicular nuclear receptor 4(TR4),also known as NR2C2(nuclear receptor subfamily 2,group C,member 2),is a transcriptional factor and a member of the nuclear receptor family.TR4 was initially cloned from human and rat hypothalamus,prostate,and testes libraries.For almost two decades,its specific tissue distribution,genomic organization,and chromosomal assignment have been well investigated in humans and animals.However,it has been very difficult to study TR4's physiological functions due to a lack of specific ligands.Gene knock-out animal techniques provide an alternative approach for defining the biological functions of TR4.In vivo studies of TR4 gene knockout mice(TR4-/-) found that they display severe spinal curvature,subfertility,premature aging,and prostate prostatic intraepithelial neoplasia(PIN) development.Upstream modulators,downstream target gene regulation,feedback mechanisms,and differential modulation mediated by the recruitment of other nuclear receptors and coregulators have been identified in studies using the TR4-/-phenotype.With the establishment of a tissue-specific TR4-/-mouse model,research on TR4 will be more convenient in the future.
文摘Objective： It is recommended that transurethral resection of the prostate （TURP） after brachytherapy should not be performed at an early stage after implantation. Herein we report our experiences and the results of channel TURP （cTURP） within six months post-implant for patients with refractory urinary retention. Methods： One hundred and ninety patients with localized prostate cancer of clinical stages Tlc to T2c were treated by brachytherapy as monotherapy at our institution from February 2009 to July 2013. Nine patients who developed refractory urinary retention and underwent cTURP within six months after brachytherapy were retrospectively reviewed and analyzed. Results： The median interval between prostate brachytherapy and cTURP was three months （range 1.5 to 5.0 months） There were no intraoperative or postoperative complications and no incontinence resulting from the surgery. All urinary retention was relieved per the American Brachytherapy Society urinary symptom score. With a mean follow-up time of 16 months （range 6 to 26 months） after cTURP, no patient experienced biochemical recurrence. The mean serum prostate-specific antigen （PSA） of the patients who underwent cTURP was 0.42 ng/ml （range 0.08 to 0.83 ng/ml） at the end of their follow-up. Conclusions： Early cTURP was found to be safe and effective in relieving urinary retention after brachytherapy and could be performed without compromising its therapeutic efficacy.
