Abstract: Objective To determine the predictive value of serum prostate specific antigen (PSA),prostate specific antigen density (PSA D) and prostate specific antigen transition zone density(PSAT) in prostate biops y. Methods Prostate biopsy was performed in 192 subjects ; among them, 184 subjects had PSA≥4 ng/ml,and 8 subjects had PSA4 ng/ml and positive findings for digital rectal examination and transrectal ultrasound, whi ch were suspicious of cancer.The associations of PSA, PSAD and PSAT with the pro state biopsy results were analyzed. Results Prostate can cer on prostate biopsy was detected in 100 of the 192 subjects (52.1%). Among th e 8 subjects with PSA4ng/ml, one had prostate rhabdomyosarcoma and 7 had BPH.A mong the 93 subjects with serum PSA20 ng/ml,80(86.0%) had prostate cancer.Amon g the 91 subjects with serum PSA from 4 to 20 ng/ml,19 (20.9%) had prostate canc er.The results indicated that for subjects with serum PSA 4-20 ng/ml and PSAD0 .10 or PSAT0.10,the sensitivity was 100%, the specificity was 11.1% or 4.2%, a nd the positive predictive value was 22.9% or 21.6%, such that negative prostate biopsy of 8.8% or 3.3% was avoided.Within the range of serum PSA of 4-20 ng/ml, in positive biopsy group and negative biopsy group,PSA values were (13.2±4.7) a nd (11.4±4.6)ng/ml,respectively (P0.05);PSAD values were 0.36±0.18 and 0. 19±0.09,respectively ( P= 0.001 );PSAT values were 0.67±0.36 and 0.32 ±0.18, respectively (P=0.000).The area under ROC curve for PSA, PSAD and PS AT were 0.613,0.810 and 0.833, respectively,which indicated that PSAD and PSAT w ere significantly better predictors than PSA(P0.05). Conclusion s When PSA level is more than 20 ng/ml,prostate biopsy should be per formed.When PSA level ranges 4-20 ng/ml,PSAD and PSAT have a greater value for p redicting whether prostate biopsy should be performed.

Abstract: 目的 评价后腹腔镜下肾癌根治术的安全性及疗效.方法2002年11月至2004年7月于后腹腔镜下行肾癌根治术46例.男24例,女22例.年龄23～86岁,平均58岁.3例因无痛性全程肉眼血尿就诊,余43例为B超体检发现.所有患者腹部均未触及肿物.B超检查报告肿物直径1.5～8.0 cm,平均4.5 cm,肿瘤位于肾上极17例,肾中部13例,肾下极16例.46例均行CT检查,41例行MRI检查,报告肿物大小均与B超相符,术前临床分期:T1N0M03例,T2N0M038例,T3N0M05例.结果本组手术时间60～255 min,平均145 min;出血量20～1000 ml,平均133 ml;32例肿瘤位于肾上极、瘤体＞6 cm、肿瘤与肾血管关系紧密者均行肾上腺切除.3例发生手术并发症,其中1例为生殖腺静脉损伤,出血约1000 ml转开放手术;1例用直线切割器切右肾静脉时,误将腔静脉切割封闭了一半,但未出血;1例为直线切割器切断肾动脉后残端喷血,用钛夹止血.病理报告:肾透明细胞癌41例,囊性肾细胞癌2例,嫌色细胞癌1例,错构瘤1例,嗜酸细胞瘤1例.随访1～20个月,平均9个月,1例因肾癌肝转移,于术后1年死亡,其余病例仍无瘤生存.结论后腹腔镜下肾癌根治术安全可靠,疗效良好。

Abstract: 目的 探讨神经原性膀胱手术方式选择与术后并发症.方法神经原性膀胱患儿94例,年龄3～19岁,平均9岁.表现为不同程度大小便失禁.选用术式包括①盆底肌加强,②膀胱颈悬吊,③膀胱扩大,④Malone术和⑤输尿管抗返流术.本组行手术组合为:①+②+③49例,①+②+③+④16例,①+②+③+⑤16例,①+②+⑤4例,②+⑥1例,①+②5例,③+⑤3例.术后半年评价疗效采用ICI-Q-SF评分和尿动力学检查、IVU,并分析并发症.结果手术前后尿失禁症状评分(16.1±1.7和8.4±2.1)、实际容量与预计容量之比(0.4±0.2和1.2±0.2)、顺应性[(3.0±1.7)和(11.9±2.4)mL/cm H2O)]、充盈末期膀胱压力[(60.8±30.7)和(46.3±24.8)cm H2O],差异均有统计学意义(P值均＜0.05).术后并发症24例(25.5%),近期12例,远期12例;盆腔感染2例,会阴感染1例,尿性腹膜炎2例,肠梗阻3例,膀胱阴道瘘1例,膀胱输尿管连接处狭窄1例,膀胱腹壁瘘2例,肛瘘2例,膀胱挛缩3例,尿路感染2例,膀胱结石3例,输尿管返流2例.结论盆底肌加强、膀胱颈悬吊和膀胱扩大手术组合是治疗神经原性膀胱基本手术.术前肠道充分准备,术中严格无菌操作,操作仔细,彻底止血,术后引流充分,坚持间歇导尿是减少术后并发症的有效方法。

Abstract: Objective To determine the expression of pr ostate hyperplasia- and cancer-related genes by real-time quantitative RT-PC R and to screen for those which can be used for clinical diagnosis of prostate c ancer. Methods Using real-time quantitative RT-PCR,the expression of 9 genes including KLK3,KLK2,KLK11,pim-1,hepsin,PSMA,AR,p27,IG F-1 in 3 prostate tissues,ie,normal tissue,BPH tissue and prostate cancer tissu e,were quantitated and their specifically differential expressions were analyzed . Results Of the 9 genes tested,4 genes,ie,KLK2, pim-1, AR and IGF-1,were differentially expressed in the 3 tissues.The differences wer e statistically significant (P0.01). Conclusions Th e combination of KLK2,pim-1,AR and IGF-1 which are specific molecular markers of prostate cancer tissue may improve the rate of early diagnosis of prostate ca ncer.

Abstract: 目的 探讨腔内治疗移植肾尿路结石的效果和策略.方法采用腔内技术治疗13例移植肾尿路结石,其中肾结石3例,金属支架结石1例,输尿管结石9例,合并输尿管口狭窄2例.结石最大直径8～48 mm,接受肾移植的时间1个月～8年.结果3例肾结石和1例金属支架结石行经皮微造瘘输尿管镜取石术成功取石.4例输尿管结石行逆行输尿管镜取石治疗;3例行经皮顺行输尿管镜取石成功,其中1例合并移植输尿管口狭窄者同时行内切开取石;1例移植输尿管口狭窄合并下端结石者,改行开放手术;1例输尿管结石直接行体外冲击波碎石术2次后排净结石.术后随访l～8年,人肾存活均良好,12例患者肾功能恢复正常,无结石复发.结论移植肾尿路结石处理应选择创伤小、效果好的腔内微创治疗,尽可能保护肾功能。

Abstract: Objective To study the relationship between chemical composition of urinary stones and metabolic disturbance. Methods 284 urinary stone patients who had undergone analysis of stone composition were evaluated;of them 191 patients had entire blood biochemistry results and 24-h urine analysis results.The relationship between stone composition and metabolic disturbance was analyzed using χ2 test. Results Calcium oxalate stones were found in 195 cases (68.7%),infection stones in 41 cases ( 14.4%),uric stones in 38 cases (13.4%),phosphate stones in 6 cases (2.1%) and cystine stones in 4 cases (1.4%).Metabolic disturbance was found in 176 (92.1%) of 191 patients with entire blood biochemistry results and 24-h urine analysis results.Among the 176 patients,hypercalciuria occurred in 27 cases (14.1%),hyperuricosuria in 54 cases (28.3%),hyperoxluria in 41 cases (21.5%),hyperphophauria in 55 cases (28.8%),hypocitraturia in 128 cases (67.0%),hypomagnesiuria in 80 cases (41.9%),24-h urine volume 2000 ml in 65 cases (34.0%),cystinuria in 4 cases (2.1%).Ninety-four cases were followed up for an average of 22 months (range,10-58 months);of them 52 cases were stone-free,and 42 cases had stone recurrence. The number of patients without metabolic disturbance was higher in stone-free group (12 cases) than that in stone recurrence group (2 cases) (P0.01).The number of patients with 4 kind of metabolic disturbances was lower in stone-free group (2 cases) than that in stone recurrence group (7 cases) (P0.01). Conclusions Urinary stone recurrence is closely related with more than one kinds of metabolic disturbances.Stone composition analysis and metabolic evaluation are very important in finding the causes and in treating and preventing urinary stones.

Abstract: 目的 探讨血清前列腺特异性抗原(PSA)、前列腺特异性抗原密度(PSAD)和前列腺移行带特异性抗原密度(PSAT)在前列腺穿刺活检中的意义.方法对192例患者行前列腺穿刺活检,其中PSA≥4 ng/ml者184例,PSA＜4 ng/ml且直肠指诊及经直肠B超有阳性发现者8例.对PSA、PSAD和PSAT与前列腺穿刺活检的关系进行分析.结果192例患者中经前列腺穿刺诊断为前列腺癌(PCa)100例,活检阳性率52.1%,其中8例PSA＜4 ng/ml者中,活检结果为前列腺横纹肌肉瘤1例,良性前列腺增生7例;93例PSA＞20 ng/ml者中80例为PCa,活检阳性率86.0%;91例PSA 4～20 ng/ml者中19例为PCa,活检阳性率20.9%.血清PSA 4～20 ng/ml患者,PSAD＞0.10或PSAT＞0.10时,敏感性均为100%,特异性为11.1%或4.2%,阳性预测值为22.9%或21.6%,可避免8.8%(8/91)或3.3%(3/91)阴性穿刺结果.血清PSA 4～20 ng/ml时,前列腺穿刺阳性组和阴性组PSA分别为(13.2±4.7)和(11.4±4.6)ng/ml(P＞0.05);PSAD分别为0.36±0.18和0.19±0.09(P=0.001);PSAT分别为0.67±0.36和0.32±0.18(P=0.000).血清PSA、PSAD和PSAT的ROC曲线下面积分别为0.613、0.810和0.833,PSAD和PSAT的ROC曲线下面积与PSA比较,差异均有统计学意义(P＜0.05). 结论PSA＞20 ng/ml时应做前列腺穿刺活检;PSA 4～20 ng/ml时,PSAD和PSAT对预测患者是否行前列腺穿刺活检有较大帮助。

Abstract: Objective To evaluate the clinical featur es , treatment regimens and prognosis of incidental prostatic carcinoma after surge ry for BPH in the PSA era. Methods From January 1994 to December 2003,a total of 1511 patients diagnosed with BPH in our institute under went TURP or prostatectomy;35 of them were found to have incidental prost atic ca rcinoma.Their age ranged from 63 to 82 years.Pathologically,34 cases had prostat ic adenocarcinoma (including 17 cases of T 1a and 17 of T 1b),and 1 ha d transitional cell carcinoma of the prostate.Eleven patients received androgen -deprivation therapy,while 24 had only watchful waiting. Results Of the 35 patients,33 were followed up for 8 to 107 months with a mea n of (55.2±28.6) months;2 were lost.Of those who were treated,8 cases survived; 1 died of prostate cancer and 1,of cardiovascular disease.Of those who had watch ful waiting,21 cases survived;2 died of the disease.The T 1a patients had a lower mean Gleason score (3.0±0.87) than T 1b patients (4.6±2.0) ( P 0.001).For those who underwent watchful waiting,no statistic significant differ ence of tumor-specific survival rate existed between T 1a and T 1b gr oups ( P =0.480).For T 1b patients,no statistic significant difference of tumor-specific survival rate existed between those having watchful waiting and those undergoing androgen-deprivation ( P =0.527). Conclusions In the PSA era,the rate of incidental carcinoma of prostate after BPH surgery was 2.3%.Watchful waiting may be a treatment choice for patients with i ncidental carcinoma.

Abstract: ObjectiveTo study the efficacy and safety of tranexamic acid in antifibrinolytic treatment to reduce bleeding after prostatectomy.MethodsA series of 177 patients with benign prostatic hyperplasia were randomly assigned to receive tranexamic acid at 2 g/d during and after prostatectomy for 3 days (group A, n =79),and epsilion aminocaproic acid (EACA) at 4 g/d during and after prostatectomy for 3 days (group B, n =98). The bleeding volume,coagulation function and adverse effects were observed.ResultsThe bleeding volume of group A on 3 post-operative days were (32.21±20.62)ml,(22.79± 16.56 )ml and (15.24±13.99)ml,respectively;and the total bleeding volume of 3 days was (70.24± 39.86 )ml.These values were less than those of group B,which was (65.10±29.40)ml,(38.89±20.14)ml, (24.00±15.64) ml,and (127.99±58.65) ml,respectively.The differences were statistically significant ( P 0.001).Pre- and post-operatively, the coagulation system had no significant change, and no major adverse effects occurred in both groups.ConclusionsTranexamic acid is more effective than EACA in reducing bleeding after prostatectomy, and both of them are safe to the patients.

Abstract: Objective To investigate the effect and molecular mechanism of cyclooxygenase-2 (COX-2) on the benign prostatic hyperplasia (BPH) in rat model Methods Thirty-six SD rats were randomly divided into 3 groups:normal control (group A,n=12),BPH model (group B,n=12) and BPH+selective COX-2 inhibitor celecoxib (group C,n=12) At the 5th week after treatment, the weight of the prostates was measured, and the morphological changes were examined under light microscopeDetection of ki-67 and TUNEL in prostatic epithelial and stromal cells was undertaken to assess the proliferation and apoptosis statusThe protein and mRNA expression of COX-2,epidermal growth factor (EGF),basic fibroblast growth factor (bFGF) and transforming growth factor-β1 (TGF-β1) were analyzed by means of immunohistochemisty and RT-PCR Results The prostate index [prostate wet weight (mg)/rat body weight (g)] of group B was significantly higher compared with those in groups A and C (188±017 vs 170±009 and 174±016,P005)Remarkable prostatic hyperplasia in group B and epithelial cell atrophy in group C was noted by microscopyEpithelial and stromal cell proliferation indices (PI) of 3 groups were 0018± 0007 and 0007±0002, 0025±0006 and 0010±0004, 0017± 0006 and 0006± 0003,respectively;the PI of group B was significantly higher than those of groups A and C (P005)Apoptosis index (AI) of group C (0019±0005) was significantly higher than those of groups A and B (0015±0004 and 0013±0003,P005) The levels of COX-2 and EGF mRNA and protein in group B were up-regulated, while TGF-β1 was down-regulated compared with those of groups A and C (P005)There was no significant difference of bFGF expression among 3 groups (P005) Conclusions The increased expression of COX-2 may play an important role in the pathogenesis of BPH by modulating the expression of growth factors and affecting the proliferation and apoptosis of prostate cells

Abstract: 前列腺炎是泌尿科临床上最常见的炎症性疾病之一.高达25%～50%的男性曾经或正在受到前列腺炎的困扰[1].我们通过多中心随机双盲安慰剂对照的方法,评估翁沥通治疗慢性前列腺炎的安全性和有效性。

Abstract: 目的 分析慢性前列腺炎(CPS)对患者生活质量的影响.方法随机选择年龄20～59岁门诊CPS患者3000例,无记名填写调查表,内容包括年龄、身高、体重、学历、性格、职业、病程、治疗情况、前列腺液情况及国际前列腺炎症状评分指数表(NIH-CPSI)、性功能情况、勃起功能国际指数问卷(ⅡEF-5)等共29项.结果回收有效调查表2498份,占83.3%.有82.7%的患者经常考虑CPS症状,81.2%患者对带着症状继续生活感到不满意、不高兴甚至很可怕,其中20～39岁组占78.2%;QOL评分9～12分者66.2%,其中20～39岁组占80.0%;1718例已婚患者中有勃起功能障碍(ED)者427例(45.0%),其中62.1%为轻度ED;ED重度影响QOL者占56.9%;患者性格内向者占59.8%,有生活压力者占73.5%,正规治疗的患者中65.0%对治疗效果不满意;QOL评分与NIH-CPSI评分、病程呈正相关(r=0.670,P＜0.01;r=0.084,P＜0.01),与年龄呈负相关(r=-0.114,P＜0.01),而与身高、体重、学历、职业、前列腺液情况、有无伴发疾病等无明显相关性(P＞0.05).结论CPS对患者生活质量的影响明显.对年轻患者的生活质量影响最大,生活质量影响程度与NIH-CPSI评分、性格、生活压力、治疗效果、病程等有关,而与身高、体重、学历、职业、性功能情况等无明显相关性。

Abstract: 目的 建立大鼠肾移植急性排斥反应(AR)模型,了解大鼠肾移植AR病理进程.方法异基因移植组由Wistar大鼠为供体,雄性SD大鼠为受体.同基因对照组供受体均为SD大鼠.肾移植术后第1、3、5、7天取移植肾组织,进行HE染色、Masson染色、PAS染色、PASM染色,光镜下观察病理改变,参照Banff 97标准进行诊断,根据Watanabe的方法进行AR严重程度的半定量评分.结果术后第1、3、5、7天异基因移植组和同基因对照组的半定量评分分别为(0.50±0.54)、(1.33±0.82)、(3.50±1.05)、(4.33±0.82)和(0.33±0.52)、(0.67±0.52)、(0.67±0.52)、(0.67±0.52).异基因移植组与同基因对照组评分比较差异均有统计学意义(P＜0.05).异基因移植组中两两比较结果:第3、5、7天评分与第1天评分比较差异有统计学意义(P＜0.05),第3天与第5、7天评分差异有统计学意义(P＜0.05),第5天和第7天评分差异无统计学意义(P＞0.05).同基因对照组各天的评分差异无统计学意义(P＞0.05). 结论SD大鼠间组织相容性高,SD大鼠作为供受体的大鼠肾移植排斥反应轻微,可作为同基因对照组;Wistar-SD大鼠间肾移植AR发生快,程度重,是良好的AR动物模型。

Abstract: Objective To review and discuss the changes of diagnostic techniques and therapeutic modalities of pheochromocytoma during the past fifty years. Methods The clinical data of 362 patients (196 men and 166 women; age range,7-75 years;mean age,38 years) with pheochromocytoma from January 1955 to July 2004 were retrospectively analyzed.The disease course ranged from 20 d to 20 years with a mean of 3.9 years.According to the premedication,the past 50-year period was divided into 3 stages;and the diagnostic techniques,premedication, anesthetic skills,surgical procedures and perioperative death rate were compared among the 3 stages. Results There were 60 patients in the first stage (1955-1975) and their diagnoses were made on urine VMA and retroperitoneal air-contrast imaging.They had no premedication except for tranquilizers.The therapeutic modality was open surgery of resecting tumors under peridural anesthesia.The perioperative mortality was 8.3% (5/60).The second stage (1976-1994) included 105 patients and they were diagnosed mainly by 24-h urine catecholamine, ultrasonography and CT.Phenoxybenzamine was taken as the regular premedication and open surgery general anesthesia was used; the mortality decreased significantly to 1.0% (1/105).The third stage (1995-2004) consisted of 197 cases.In addition to 24-h urine catecholamine,ultrasonography and CT, 131I-MIBG scan was used as the specific diagnostic technique for pheochromocytoma widely.The premedication was phenoxybenzamine and urapidil.The microcirculation imaging analysis was used to judge the volume expansion preparation. Laparoscopic resection of the tumor under general anesthesia was adopted as the regular means.The perioperative mortality was 0.5% (1/197). Conclusions The diagnostic techniques for pheochromocytoma have become enriched and mature.The premedication has been standardized and included more medicines.The microinvasive surgery has become the current method for resecting tumors,and the perioperative mortality has become significantly decreased.

Abstract: Objective To investigate the role of retroperitoneal lymph node dissection (RPLND) in the treatment of testicular cancer Methods The clinical data of 39 cases (age range,20-58 years;median age,29 years) of germ cell tumor who underwent RPLND were retrospectively analyzedOf the 39 cases,17 had the tumors on the left side and 22,on the rightOne case was of seminoma,and the other 38 were of non-seminomatous germ cell tumor (NSGCT)According to the clinical examinations and radiology, 20 cases were of stage Ⅰ,15 of stage Ⅱ,and the rest 4 could not be staged Results Of the 39 cases,10 with stage I tumors underwent nerve-sparing modified RPLND and the other 29 underwent bilateral RPLNDNo metastasis was found in the dissected tissues in 22 cases,while metastasis,in 17 (including 4 of clinical stage I)All the patients with pathological metastases or elevation of blood tumor markers received postoperative chemotherapyFollow-up was carried out for 1-149 monthsThe disease-free survival rate was 974%(38/39)Of the 10 cases receiving modified RPLND,8 regained their ejaculation function Conclusions The probability of presence of the non-seminomatous components must be considered in the diagnosis and follow-up of seminoma cases,and the RPLND should be done if necessaryNerve-sparing modified RPLND should be performed for clinical stage Ⅰ patients;while postoperative chemotherapy should be chosen for pathological stage Ⅱ patients

Abstract: Objective To evaluate the efficacy of laparoscopic radical prostatectomy in patients with prostate cancer.Methods The clinical data of 159 patients who underwent laparoscopic radical prostatectomy from March 2000 to August 2003 were reviewed.The patients' mean age was 58 years(range,42-74 years).Bilateral pelvic lymph node dissection was performed simultaneously in 57 cases(35.9%).All the cases had pathological diagnosis of prostate cancer by preoperative biopsy.Biopsy results showed Gleason grade 3+3 tumor in 129 cases(81.1%),3+4 in 23 cases(14.5%),4+3 in 4 cases(2.5%) and 4+4 in 3 cases(1.9%).TNM staging showed T_(1c) stage tumor in 126 cases(79.3%),T_(2a) in 33 cases((20.7)%).Results The mean skin-to-skin operative time was 298 min(range,165-660 min) and estimated blood loss was 293 ml(range,50-2500 ml).Intraoperative severe complications occurred in 15 cases((9.4)%),of whom 6 cases(3.8%) underwent conversion to an open surgery.No patient died intraoperatively.Of the 159 cases,158 were pathologically diagnosed as prostate cancer and 1 case was diagnosed as benign hyperplasia of prostate with acute prostatitis postoperatively.The specimens from 34 cases(21.5%) in 158 cases of prostate cancer had positive margins.The first 53 cases of the cohort had 1-year follow-up postoperatively.Among them,31 cases(58.5%) who had erectile function were divided into 3 groups based on the international index of erectile function(IIEF-5) for the evaluation of the postoperative erectile function.Postoperative IIEF-5 scores were significantly decreased,but the difference between groups was not significant.Of the 53 cases,36(67.9%) could have intercourse by the use of medications such as Viagra,Caverject or MUSE.Urinary incontinence occurred in 6 cases(11.3%).Conclusions These results suggest that laparoscopic radical prostatectomy is a relatively safe,minimally invasive surgery with low morbidity and rapid recovery,and has favorable postoperative quality of life outcomes.The laparoscopic approach can maintain the oncological control of open surgery with added benefits for the patient.However,long-term cancer control and functional results need further investigation.

Abstract: Objective To investigate the safety and efficacy of vardenafil,a novel selective phosphodiesterase type 5 inhibitor, in the treatment of male erectile dysfunction (ED). Methods This multicenter,randomized,double blind,placebo controlled study was performed at 7 domestic sites.A total of 624 men with mild to severe ED were enrolled in this trial of 4 weeks of washout and 12 weeks of treatment with either placebo or 5,10,20 mg of vardenafil on demand but not more than once a day. Results Analysis of safety and efficacy of vardenafil was performed on 602 cases who completed the trial.Primary endpoints were Q3 (vaginal penetration) and Q4 (maintenance of erection) of the International Index of Erectile Function (IIEF).In the intent to treat population (n=602),the changes from baseline with 5,10,20 mg vardenafil groups were all improved ( P 0.0001 ) for Q3,and were similarly improved for Q4,compared with placebo group ( P 0.0001 ).All doses of vardenafil improved all IIEF domains compared with placebo ( P 0.0001 ).The percentage of successful intercourses was between 59% and 71% for the 3 doses of vardenafil groups.The main drug related adverse events were flushing (9%-13%) and headache/dizziness (7%-13%),which were mild and could be self relieved. Conclusions Vardenafil at doses of 5,10,20 mg is safe,efficacious and well tolerated in the treatment of patients with mixed ED etiologies.

Abstract: 目的 评价腔内剜除法在经尿道前列腺汽化电切除术(TUVP)中的应用价值.方法在前列腺双极汽化电切术中结合镜鞘及电切袢的应用,于前列腺尖部寻找到增生腺体和外科包膜的界面,沿此间隙将增生腺体从外科包膜上环状剥离、剜除,切碎.通过临床1000例应用研究,对术中出血量、手术时间、安全性及术后出血时间、出血量及拔除尿管时间和预后效果进行观察分析.结果采用新的切割方法前列腺尖部被完整剜除,无需修整,尖部尿道成为由外科包膜构成的喇叭口状自然界面,经过剜除的增生腺体,界面清楚,血供减少,利于快速切除,不易出现包膜损伤,切除效率明显提高.1000例手术顺利,术后发生短期尿道刺激症者150例,发生膀胱颈挛缩6例,尿道狭窄10例.手术时间、出血量随着前列腺体积和重量的增加而相应延长或增加,与前列腺体积、重量呈正相关(P＜0.05).随访6～18个月,无死亡病例,无再次手术及永久性尿失禁等并发症发生.结论腔内剜除术是TUVP术中一种切实可行的新技术,值得临床应用与推广。

Abstract: 目的 比较后腹腔镜结核肾切除术(包括后腹腔镜单纯性肾切除术和后腹腔镜包膜下肾切除术)与开放手术方法的应用价值.方法①行腹腔镜结核肾切除术22例(A组).男7例,女15例.年龄23～53岁,平均年龄43岁.左肾14例,右肾8例.②同期行结核肾开放性肾切除22例(B组).男9例,女13例.年龄27～51岁,平均年龄39岁.左肾15例,右肾7例.两组手术均由同一组医师完成.比较两种方法的手术时间、术中失血量、术后平均住院时间、卧床时间.结果A组行单纯肾切除者17例,另5例因肾周严重粘连改行包膜下肾切除.B组改行包膜下肾切除者7例.A组手术时间为(93.0±12.6)min,术中失血量(78.3±60.6)ml、术后平均住院时间为(3.3±0.9)d、卧床时间为(1.0±0.2)d,B组上述指标分别为(92.6±35.5)min、(160.0±120.0)ml、(9.1±0.8)d和(3.9±0.4)d;两组手术时间比较差异无统计学意义;但A组术中失血量、术后平均住院时间及卧床时间明显优于B组.结论与开放手术相比,后腹腔镜结核肾切除术具有创伤小、出血少、恢复快的优点,后腹腔镜包膜下肾切除术能有效处理粘连极重的无功能结核肾。

Abstract: 目的 观察伐地那非治疗勃起功能障碍的安全性和有效性.方法采用多中心、随机、双盲、安慰剂对照的方法,在国内7家中心对624例勃起功能障碍者口服伐地那非的勃起功能改善情况进行临床观察.患者随机按1:1:1:1进入安慰剂组及伐地那非5、10、20 mg组,每组各156例,完成4周洗脱期和12周治疗期.患者按需在性交前1 h服用1片研究药物.每日最多服用1次研究药物.观察治疗12周后国际勃起功能指数(IIEF)问卷中有关勃起功能部分(问题1～5和15)的得分,患者日记中有关插入的成功率及成功保持勃起的成功率. 结果共有602例(96.5%)进入安全性评估和意向性分析,各组分别为安慰剂组148例(94.9%)、5 mg组151例(96.8%)、10 mg组150例(96.2%)、20 mg组153例(98.1%).完全符合方案人群共468例(75.0%),各组分别为:安慰剂组120例(76.9%)、5 mg组118例(75.6%)、10mg组106例(68.0%)、20 mg组124例(79.5%).意向性分析人群的IIEF勃起功能部分(问题1～5,15)得分的统计结果,用药12周后,伐地那非5 mg组、10 mg组和20 mg组的平均得分基线分别为13.3分、14.1分和13.6分,分别增加到22.2分、22.8分和23.6分,与安慰剂组比,均P＜0.0001.对于插入成功率,安慰剂组、伐地那非5 mg、10 mg、20 mg组基线值分别为44.6%、44.7%、51.2%和45.0%;用药12周后分别增加到54.6%、79.3%、81.5%和86.0%,三个剂量组与安慰剂组相比均有明显提高,均P＜0.0001.在完全性交成功率方面,伐地那非5 mg组、10 mg组和20 mg组的基线值分别为10.3%、6.7%和8.6%,用药12周后,分别增加到59.8%、67.1%和71.5%,与安慰剂组比,均P＞0.0001.与药物相关的主要不良事件为潮红(9%～13%)、头痛、头晕(7%～13%),其严重程度多为轻度,且可以自行缓解.结论伐地那非治疗勃起功能障碍安全、有效、耐受性好。

Abstract: Objective To evaluate the detection of survivin and minichromosome maintenance 5 protein (MCM5) in urine for the diagnosis of bladder cancer. Methods Survivin and MCM5 in urine samples from 70 patients with bladder cancer (54 men and 16 women;mean age,61 years;25 cases of G 1,27 of G 2 and 18 of G 3),40 patients with benign urinary diseases (mean age,54 years) and 10 healthy volunteers (mean age,55 years) were tested by RT-PCR. Results The positive rates and expression levels of survivin and MCM5 in urine sediments of bladder cancer patients increased with increasing pathological grades and clinical stages;however,the differences of survivin expression between pathological grades and clinical stages were not significant(P0.05),while those of MCM5 were significant (P0.05).The sensitivities of survivin,MCM5,combination of survivin and MCM5,and urine cytology to detect bladder carcinoma were 84.3%(59/70),87.1%(61/70),98.6%(69/70) and 48.6% (34/70),respectively.The sensitivities of the first 3 were significantly higher than that of the last (P0.05).The sensitivity of combination of survivin and MCM5 to detect bladder carcinoma was significantly higher than individual evaluation of survivin or MCM5(P0.05).But the difference of sensitivities between survivin and MCM5 was not significant(P0.05).The specificities of survivin,MCM5,combination of them and cytology were 94.0%,92.0%, 88.0% and 100.0%,respectively. There was no significant difference between them(P0.05). Conclusions The detections of survivin and MCM5 in urine sediments are sensitive and non-invasive diagnostic tests for bladder cancer.The combination of survivin and MCM5 may be more effective than either of them alone.

Abstract: 目的 探讨外源性骨髓间充质干细胞(MSCs)移植对缺血再灌注肾损伤的可能保护作用.方法取SD雄性大鼠骨髓,梯度离心法分离MSCs,采用4,6-联脒-2-苯基吲哚(DAPI)标记.32只雌性SD大鼠建立缺血再灌注肾损伤模型后随机分为移植组和对照组,移植组于缺血45 min后经下腔静脉注入用DAPI标记的MSCs,对照组注入等量生理盐水.术后每天经腹腔注射5-溴脱氧尿苷嘧啶(BrdU),并分别于术后1、2、3、4 d处死大鼠,留取血标本,观察血清肌酐(Cr)和尿素氮(BUN)水平.留取肾组织,荧光显微镜及免疫组化染色方法观察移植MSCs在肾组织中的分布及肾细胞增殖状况,并采用蓖麻血凝素(RCA)对迁移入肾脏的MSCs分化状况进行鉴定.结果术后第1、2天,移植组大鼠血清BUN水平(31.93±1.49、19.58±1.58 mmol/L)明显低于对照组(41.03±2.14、26.45±1.74 mmol/L,P＜0.05);第3、4天2组间BUN水平差异无统计学意义(P＞0.05);第1、2、3天移植组大鼠血清Cr水平(77.47±4.77、57.45±2.41、44.93±3.97μmol/L)均显著低于对照组(102.37±3.59、67.50±2.92、53.25±2.73μmoL/L),差异有统计学意义(P＜0.05).细胞增殖状况:术后第1天偶见BrdU阳性细胞,第2天2组大鼠肾组织中均可见较多BrdU阳性细胞,并随时间延长阳性细胞逐渐增多,且移植组阳性细胞数(33.71±8.50、57.60±4.88、116.29±6.99)明显多于对照组(19.67±5.20、26.88±5.89、71.71±8.44),差异有统计学意义(P＜0.05).移植组术后第3天肾组织内可见DAPI标记细胞,第4天DAPI标记细胞明显增多,且多数标记细胞能结合RCA.结论移植的外源性骨髓MSCs能够迁移、定居于缺血再灌注损伤后的肾组织中并分化为肾小管上皮细胞;MSCs移植可促进损伤肾组织的细胞再生,对缺血再灌注肾损伤具有一定的保护作用。

Abstract: Objective To work out the uroflow parameters of normal children in Changsha area.Methods Overall,1048 tests of uroflow rate were performed on 1024 healthy children.The results of these tests were classified into several groups by sex,age,body surface area and urine volume voided.These data were statistically analyzed with SPSS10.0 software.For each group,the nomograms of uroflow parameters(including urine volume, body surface area,mean uroflow rate,and maximum uroflow rate) were drawn for clarifying the relationship among them.Results The maximum uroflow rate(Qmax) of the boys younger than 7 years increased with age;the Qmax increased 1.7ml/s with age increasing 1 year.The boys older than 7 years had the Qmax similar to that of adults.The Qmax of the girls younger than 9 years increased with age,the Qmax increased 1.2ml/s with age increasing 1 year.The girls older than 9 years had the Qmax similar to that of adults.In children,the Qmax,mean uroflow rate and urine volume increased with the increase in body surface area.Similarly,the Qmax and mean uroflow rate increased with the increase in urine volume voided.Conclusions The Qmax of boys younger than 7 years and girls younger than 9 years is obviously related with age.

Abstract: Objective To investigate whether the adenoviral-mediated expression of the antisense cDNA of the human PDE5A1 promoter gene can improve erectile function in rabbits with diabetes mellitus (DM). Methods Twenty-five male rabbits was randomly divided into 5 groups as follows:4 treatment (n=5 in each group) and normal control (n=5) groups. Alloxan was injected intravenously into the treatment groups to establish diabetic erectile dysfunction in animal models. The pAd/CMV/V5/antisense-PDE5A1, pAd/CMV/V5-GW-lacZ (β-gal group), vehicle and 0.9% NaCl were transfected into the corpus cavernosum of the DM rabbits in the 4 treatment groups, respectively. Seven days after transfection, the intracavernosal pressure during pelvic nerve stimulation (NSICP) was compared with that in normal control animals.Adenoviral transfection efficiency of β-gal reporter gene was measured by Western blot analysis, and cGMP levels in cavernosal tissue were detected by ELISA. Results Seven days after transfection with pAd/CMV/V5/antisense-PDE5A1, cGMP level in cavernosal tissue (25.6±2.5) fmol/mg protein was significantly higher than those in β-gal group [(8.8±0.9) fmol/mg protein],vehicle group [(8.3±1.1) fmol/mg protein],DM control group [(7.4±0.8) fmol/mg protein,P0.05]. The increase in NSICP of the pAd/CMV/V5/antisense-PDE5A1-transfected rabbits [(66.2±3.6) mmHg] was significantly higher than those of β-gal group [(38.2±2.5) mmHg], vehicle group [(35.2±2.2) mmHg],and DM control group [(36.6±2.7) mmHg,P0.05].There was no significant difference between the pAd/CMV/V5/antisense-PDE5A1 group and normal control group [(65.2±3.2) mmHg,P0.05].Adenoviral expression of β-gal reporter gene was significantly higher in cavernosal tissue in β-gal group than in other groups. Conclusions These results suggest that in vivo adenoviral gene transfer of antisense cDNA of the human PDE5A1 promoter gene to penis can improve erectile function in DM rabbits. The PDE5A1 promoter gene may be a novel target gene for gene therapy of ED.

Abstract: ObjectiveTo evaluate the role of transurethral resection of the prostate (TURP) in the management of prostate carcinoma.MethodsTURP were randomly performed on 19 suspected patients with prostate carcinoma, based on their mean serum PSA level (14.5 ng/ml) and negative result of anal touch,so as to take more biopsy samples and to make histopathologic diagnosis.Meanwhile,another 8 patients with prostate carcinoma underwent palliative TURP so as to resolve bladder outlet obstruction.ResultsOf the 19 suspected patients, 6 (33%) were pathologically diagnosed to have prostate carcinoma.These 6 patients were all alive during a follow-up for 3 months to 6 years.Obstructive symptom was relieved in 4 patients who underwent palliative TURP,but repeat palliative TURP was needed in 2 patients 3 months after initial operations.ConclusionsIn certain circumstances,TURP may play a role in the diagnosis of prostate carcinoma. In addition, it relieves obstructive symptom caused by enlarged prostate. However, the long-term effects are unpredictable.

Abstract: Objective To investigate the genitourinar y phenotype in androgen receptor knockout (ARKO) mice. Methods Using Cre-lox technique, the female Flox-AR mice were crossed with male ACTB-Cre mice,and the genotype of their filial generations was confirmed by PCR .By screening,5 ARKO mice were generated as study subjects and 5 wild type mice served as controls.The genitourinary phenotypes of the 2 groups were compared.Th e anal genital distance and testis weight were measured;serum testosterone and e stradiol levels were assayed by ELISA. Results The anal genital distance in ARKO group was (0.5±0.1)cm,while it was (1.1±0.1)cm in wil d type group.The prostate,seminal vesicle, epididymis and spherical cavernous bo dy muscle were absent in ARKO group with the reduced testis weight of (0.006 ± 0.001)g;while those were normal with the testis weight of (0.086±0.002)g in w ild type group.The serum testosterone level in ARKO group was (0.056±0.045)nmol /L,and it was (0.843±0.736)nmol/L in wild type group.The serum estradiol level in ARKO group was (1390.1±294.3)pmol/L,and it was (786.2±150.8)pmol/L in wild type group.The differences were statistically significant between the 2 groups ( P 0.05). Conclusions In ARKO mice,the prostate,s eminal vesicle,epididymis and spherical cavernous body muscle are absent with th e reduced testis,decreased androgen and increased estrogen levels.It is suggeste d that androgen receptor plays an important role in male genitourinary system.

Abstract: 目的 寻求长沙地区儿童尿流率正常值及其列线图.方法对1024名正常儿童进行1048次尿流率检测.将所得资料按性别、年龄、体表面积、排尿量分组后进行统计学分析,并绘制出各组相应的列线图以阐明尿量、体表面积、平均尿流率、最大尿流率4者的相互关系.结果正常儿童尿流率曲线为典型的钟形曲线. 7岁者其最大尿流率同成年人相仿. 9岁其最大尿流率同成年人相近.儿童最大尿流率、平均尿流率及排尿量均随体表面积增加而增加,同时,最大尿流率、平均尿流率也均随排尿量的增加而增加.结论<9岁的女童和<7岁的男童最大尿流率的正常值有明显的年龄依从性。

Abstract: Objective To compare the therapeutic effect of laparoscopic radical cystectomy with orthotopic ileal neobladder (LRC-INB) vs open radical cystectomy (ORC-INB). Methods A total of 81 patients were evaluated including 33 undergoing LRC-INB (group A) and 48,ORC-INB (group B) from June 1994 to September 2004 at our institution.The parameters for analysis included operative time,surgical method,blood loss,therapeutic effect,complications and hospital stay.Statistics included t-test and chi-square analysis (P0.05 was considered statistically significant). Results There was no significant difference in factors of patients at baseline between the 2 groups.The mean operative time was 390 min in group A vs.330 min in group B.The mean intraoperative blood loss was 460 ml in group A vs.1200 ml in group B.The mean recovery time of intestinal function was 3-4 d in group A.vs 4-5 d in group B.The positive rates of pelvic lymphadenectomy was 18.2% (6 cases) in group A and 18.8% (9) in group B.Three to 6 months after surgery,the patients of group A had 93.9% of daytime continence and 87.9% of nocturnal continence,while group B had 90.5% and 85.7%,respectively.The Qmax of the 2 groups were (18.4±6.1)ml/s vs.(15.7±5.5)ml/s with no significant difference of volume,pressure and residual urine volume (RUV) of neobladder.The IVU and retrograde contrast examination of neobladder showed that all the patients’ ureters had mild expansion without obstruction and reflux.The neobladder’s form and size were close to normal bladder without residual urine.The stoma of urethra and neobladder was patent and urine blew off from the papillae of ureter under the cystoscope.The complication rate of group A was 18.2%,with 2 cases of urine leakage,1 of pelvic cavity infection,2 of intestinal obstruction and 1 of vesicovaginal fistula.By contrast,the complication rate of group B was 31.3%,with 4 cases of urine leakage,5 of incision infection,2 of pulmonary infection,2 of pelvic cavity infection,1 of intestinal obstruction and 1 of urethrostenosis.Both groups had no rectal injury,intestinal fistula,entocele and other serious complications or perioperative death. Conclusions LRC-INB is of less blood loss,shorter intestinal recovery time,less complications,and better urine control,but longer operative time than ORC-INB.There is no significant difference in volume,pressure and RUV of neobladder,upper urinary tract function and tumor radical resection between the two approaches.

Abstract: 目的 探讨125I放射性粒子永久植入治疗前列腺癌的疗效、适应证和并发症. 方法应用Prowess 2.42治疗计划系统经直肠超声引导,125I放射性粒子植入治疗前列腺癌患者5例,临床分期T2b 4例,T3 1例.Gleason评分7分3例,6分1例,9分1例.术前PSA 5.3～8.7 ng/ml. 结果治疗后随访12～18个月.5例患者PSA明显下降,12个月后均低于0.5 ng/ml;术后3个月开始前列腺体积缩小;术后短期出现不同程度的尿路刺激症状,IPSS评分上升,尿流率下降,但3个月后逐渐好转.患者未出现血尿、血便、直肠溃疡等严重并发症. 结论 125I放射性粒子永久植入适用于临床局限性前列腺癌,疗效好,并发症少,并有较好的放射安全性。