Objective To assess the efficacy of finasteride in treating perioperative bleeding in patients undergoing transurethral resection of the prostate (TURP). Methods We searched MEDLINE (1966 to 2005), EMBase (1984 to 2004), CBM (1980 to 2005), The Cochrane Library (Issue 4, 2005) and relevant journals to identify cl inical trials involving finasteride in patients undergoing TURP. We also checked the references in the reports of each included trial. The qual ity of randomized controlled trials (RCTs) was assessed according to the methods recommended by The Cochrane Collaboration, and the qual ity of non-RCTs was assessed based on the methods recommended by Jiang-ping Liu, Stroup and Hailey. Two reviewers extracted data independently and data analyses were conducted with The Cochrane Collaboration’ s RevMan 4.2. Result We included 4 RCTs and 1 non-RCT. The qual ity of 3 RCTs was graded C and the other one was graded B. The quality of the non-RCT was relatively high. Meta-analyses showed that with comparable age, international prostate symptom score, prostate specific antigen, preoperative volume of prostate and excision volume between the two groups (Pgt;0.05), the perioperative bleeding volume (WMD –85.44, 95%CI –117.31 to –53.58), the bleeding volume per gram of resected prostate tissue (WMD –3.5, 95%CI –6.34 to –0.58) and hemoglobin reduction (WMD –1.61, 95%CI –1.96 to –1.26) of the finasteride group were significantly smaller than those of the control group. Conclusion The evidence currently available indicates that preoperative use of finasteride may reduce bleeding in patients undergoing TURP.
ObjectiveTo systematically evaluate the efficacy and safety of simultaneous transurethral resection of bladder cancer and prostate (TURBT+TURP) in the treatment of bladder cancer with benign prostatic hyperplasia (BPH). MethodsWe searched PubMed, EMbase, The Cochrane Library, Web of Science, CBM, CNKI, WanFang Data and VIP from inception to January 2015, to collect randomized controlled trials (RCTs) and cohort studies investigating the efficacy and safety of TURBT with TURP in the treatment of bladder cancer with BPH. Two reviewers independently screened literature, extracted data, and assessed the risk bias of included studies, and then meta-analysis was performed using RevMan 5.3 software. Results3 A total of 3 RCTs (n=137) and 10 retrospective cohort studies (n=998) were included. The results of meta-analysis showed that there were no significant differences between the simultaneous resection group and the control group in the overall recurrence rate (RCT:OR=0.55, 95% CI:0.24 to 1.24, P=0.15; retrospective cohort study:OR=0.78, 95% CI:0.60 to 1.01, P=0.06), postoperative recurrence rate in the prostatic fossa/urethra (RCT:OR=1.40, 95% CI:0.28 to 7.60, P=0.68; retrospective cohort study:OR=1.36, 95% CI:0.49 to 3.74, P=0.55), progression rate (OR=0.93, 95% CI:0.53 to 1.61, P=0.79) and overall perioperative complication rate (RCT:OR=0.35, 95% CI:0.08 to 1.55, P=0.17; retrospective cohort study:OR=0.1.75, 95% CI:0.44 to 6.98, P=0.43). ConclusionCompared with only TURBT or sequential TURBT and TURP, simultaneous TURBT and TURP do not increase the overall recurrence rate, postoperative recurrence rate in the prostatic fossa/urethra, progression rate and overall postoperative complication rate. However, due to the limited quality and quantity of included studies, larger sample size and higher quality RCTs are needed to verify the above conclusion.
ObjectiveTo investigate the effect of suprapubic catheterization(SPC) by using central venous catheter (CVC) on the perioperative complications in middle and low rectal cancer surgery. MethodsThe clinical data of 141 patients with middle and low rectal cancer underwent operation in Shengjing Hospital of China Medical University from April 2012 to January 2015 were collected. There were 65 patients performed SPC by using CVC, 76 patients performed routine transurethral catheterization(TUC). The incidences of bacteriuria and urinary retention, recatheterization rate, duration of catheterization, and catheter-related pain were analyzed and compared between these two groups. Results①Compared with the TUC, the SPC by using CVC could significantly reduce the incidence of bacteriuria(P=0.002), espe-cially in female(P=0.006), ≥60 years old(P=0.001), low rectal cancer(P=0.003), open surgery(P=0.018), Miles(P=0.016), and Dixon(P=0.032).②There was no significant difference in the incidence of urinary retention(P=0.464) between the SPC by using CVC and the TUC.③Compared with the TUC, the SPC by using CVC could significantly reduce the inci-dence of recatheterization rate(P=0.001), especially in the patients with male(P=0.016), ≥60 years old(P=0.008), low rectal cancer(P=0.019), laparoscopic surgery(P=0.013), and Miles(P=0.037).④Compared with the TUC, the point of catheter-related pain was significantly lower in the SPC by using CVC(P=0.001), no matter males(P=0.005) or females(P=0.010), aged 60 years and older(P=0.023) or younger(P=0.034), middle rectal cancer(P=0.017) or low rectal cancer(P=0.046), open surgery(P=0.033) or laparoscopic surgery(P=0.021), Dixon(P=0.019) or Miles(P=0.035).⑤The duration of catheterization was similar between the SPC by using CVC and the TUC(P=0.597). ConclusionSPC by using CVC is a safer, more effective and more acceptable method of bladder drainage in middle and low rectal cancer surgery as compared with routine TUC.
Objective To evaluate the effectiveness and safety of chemotherapeutics bladder irrigation (CBI) after transurethral resection (TR) in the treatment of cystitis glandularis (CG). Methods Databases including MEDLINE, The Cochrane Library, EMbase, VIP, CNKI and CBM were searched from January 2001 to November 2011 to collect randomized controlled trials (RCTs) and case-control studies (CCSs) on pirarubicin or mitomycin bladder irrigation after TR in the treatment of CG. Two reviewers independently screened articles according to the inclusion and exclusion criteria, extracted data and evaluated the quality of the included studies. Then meta-analysis was performed using RevMan 5.0. Results A total of 11 articles involving 5 RCTs and 6 CCSs were included. Among the total 1032 patients involved, 497 patients were in the control group treated by TR alone, while the other 535 patients were in the treatment group given CBI after RT. There were two subgroups, one involving 347 patients irrigated by pirarubicin in 7 studies, and the other involving 188 patients irrigated by mitomycin in 4 studies. The results of meta-analysis showed: (a) pirarubicin bladder irrigation after TR could increase both short-term and long-term cure rates and decrease both short-term and long-term relapse rates, but no significant differences were found in both short-term and long-term improvement rates, compared with the control group. As for the safety, pirarubicin was similar to the control group in the incidence of urinary irritation, but it was superior in the incidence of bloody urine; and (b) mitomycin bladder irrigation after TR could increase long-term cure rate and decrease long-term relapse rate, but no significant differences were found in short-term cure rate and short-term improvement rate, compared with the control group. Mitomycin was similar to the control group in incidence of urinary irritation and bloody urine. Sensitivity analyses indicated the outcomes regarding to some indexes in different studies were inconsistent. Conclusion Based on the current evidence, pirarubicin or mitomycin bladder irrigation after TR can increase long-term cure rate and decrease long-term relapse rate in treating CG, but pirarubicin tends to easily cause bloody urine. For the inconsistent outcomes of different studies, the results of this meta-analysis are instable and highly possible to be inconsistent to the future outcomes, hereby it is uncertain of the better effectiveness of CBI after, TR compared with TR alone, and more high-quality and large-scale RCTs are needed to be performed.
Tissue engineering technology and stem cell research based on tissue engineering have made great progresses in overcoming the problems of tissue and organ damage, functional loss and surgical complications. Traditional method is to use biological substitute materials to repair tissues, while tissue engineering technology focuses on combining seed cells with biological materials to form biological tissues with the same structure and function as its own to repair tissue defects. The advantage is that such tissue engineering organs and tissues can solve the problem that the donor material is limited, and effectively reduce complications. The purpose of tissue engineering is to find suitable seed cells and biomaterials which can replace the biological function of original tissue and build suitable microenvironment in vivo. This paper mainly describes current technologies of tissue engineering in various fields of urology, and discusses the future trend of tissue engineering technology in the treatment of complex urinary diseases. The results of this study show that although there are relatively few clinical trials, the good results of the existing studies on animal models reveal a bright future of tissue engineering technology for the treatment of various urinary diseases.
ObjectiveTo evaluate the effect of postoperative no indwelling urethral catheters in lung operation. MethodsIn this prospective cohort study, we recruited 100 patients who were scheduled for pulmonary lobectomy under general anesthesia in a single institution of Thoracic Surgery Department in West China Hospital between April and December 2014. These patients were divided into two groups including a no indwelled urethral catheter group (NIUC, 50 patients) and an indwelled urethral catheter group (IUC, 50 patients). The clinical effect was compared between the two groups. ResultsThere was no statistical difference in incidence of postoperative urinary retention or urinary tract infection between the two groups (P=0.433, 0.050). However, the comfort degrees(0 degree) of patients in the NICU group was significantly higher than that of the ICU group with a statistical difference (P=0.002). While postoperative hospitalization time in the NICU group (P=0.023) was shorter than that in the ICU group (P=0.004). Prostatic hyperplasia was the high risk factor for the lung postoperative urinary retention (P=0.056). ConclusionPostoperative no indwelling urethral catheters in lung operation has the benefit of improving the comfort degrees of inpatients and increasing the postoperation urinary retention.
ObjectivesTo systematically evaluate the efficacy and safety of the transurethral bipolar plasmakinetic prostatectomy (TUPKP) versus holmium laser enucleation of the prostate (HoLEP) for treatment of benign prostatic hyperplasia (BPH).MethodsPubMed, EMbase, The Cochrane Library, CBM, CNKI, WanFang Data and VIP databases were electronically searched to collect randomized controlled trials (RCTs) on the efficacy and safety of TUPKP and HoLEP for treatment of BPH from inception to January 2018. Two reviewers independently screened literature, extracted data and assessed the risk of bias of included studies. Then, the meta-analyses were performed by using RevMan 5.3 software.ResultsA total of 9 RCTs involving 784 patients were included. The results of meta-analyses showed that, in efficacy outcomes, TUPKP was superior to HoLEP in Qmax at 48 months, and was inferior to HoLEP in PVR at 3 months, Qmax in 60 and 72 months, and IIEF-5 at 48 and 72 months. No significant association was found between two groups in Qmax from 1 to 36 months, IPSS from 1 to 72 months, prostate volume, PVR from 6 months, IIEF-5 from 1 to 24 months, QoL at 1 to 36 months, and resected prostate weight. As for safety, TUPKP was superior to HoLEP in operation time, while inferior to HoLEP in blood loss during procedure, hospital stay, catheterization period, bladder irrigation period, irrigation fluid, massive hemorrhage and hematuresis. No significant association was observed between two groups in serum sodium decrease, hemoglobin decrease, PSA, postoperative urine retention, blood transfusion, cystospasm, temporary incontinence, urinary tract infection, TURS, epididymitis, temporary difficulty in urination, urinary tract irritation syndrome, reoperation, retrograde ejaculation, urinary incontinence, ED and urethrostenosis.ConclusionsCurrent evidence shows that the efficacy and safety of TUPKP and HoLEP for treatment of BPH are similar. Due to limited quality and quantity of the included studies, more high quality studies are required to verify above conclusions.
Objective To evaluate the effect of pretreatment with epristeride on decreasing intraoperative bleeding during transurethral resection of prostate (TURP) and to study its mechanism. Methods A total of 60 patients with benign prostatic hyperplasia undergoing TURP were divided into two groups: 30 patients were pretreated with epristeride 5 mg×2 daily for 7 to 11 days before TURP, and 30 patients did not receive any pretreatment. The operations for the two groups of patients were conducted by the same doctors. The operation time, the weight of resected prostatic tissue, and the volume of irrigating fluid were recorded. Blood loss, bleeding index, and bleeding intensity were calculated. Microvessel density (MVD), vascular endothelial growth factors (VEGF), and nitric oxide synthase type III (eNOS) expression were measured by the immunohistochemistry SPmethod in prostatic tissue. Results In the epristeride and control groups, the mean blood loss was 179.51±78.29 ml and 237.95±124.38 ml (Plt;0.05); the mean bleeding index was 7.68±3.94 ml/g and 9.73±3.42 ml/g (Plt;0.05); the mean bleeding intensity was 2.43±1.03 ml/min and 3.30±1.50 ml/min (Plt;0.05); the mean value of MVD was 18.80±5.68 and 23.70±4.91 (Plt;0.05); the mean rank of VEGF was 23.48 and 31.77 (Plt;0.05); and the mean rank of eNOS was 22.36 and 31.14 (Plt;0.05), respectively. Conclusion Pretreatment with epristeride decreases intraoperative bleeding during TURP. The preliminary results suggest that angiogenesis in the prostatic tissue is suppressed.
ObjectiveTo discuss the reoperation methods of urethral stricture after urethroplasty of hypospadias and their effectiveness.MethodsBetween September 2010 and April 2018, 169 patients with urethral stricture after urethroplasty of hypospadias, who underwent ineffective conservative treatments first, were accepted. The age ranged from 1 year and 7 months to 41years with a median age of 5 years and 8 months. The stricture located at the external urethral orifice in 80 cases, internal anastomosis connection in 87 cases, and constructed urethra in 2 cases. The symptoms of urethral stricture occurred at 2 weeks to 52 months after urethroplasty, with a median time of 4.5 months. The patients with external urethral orifice stenosis were treated with urethral meatus augmentation (74 cases) and urethral advancement (6 cases). The patients with internal anastomosis connection stenosis were treated with internal urethrotomy with urethroscopy (10 cases), urethrotomy and one-stage urethroplasty (26 cases), and urethrostomy (51 cases) including 43 cases of two-stage urethroplasty. The patients with constructed urethral stricture were treated with urethrolysis.ResultsOne hundred and fifty-four patients were followed up 6–86 months with an average of 47 months. The stenosis was relieved in 137 cases, and re-stenosis in 12 cases, urethral fistula in 4 cases, all of which were treated successfully. In addition, 1 case with mild urethral diverticulum did not need to be treated.ConclusionIf it is ineffective for the conservative treatment of urethral stricture after urethroplasty of hypospadias, appropriate surgical treatments could be selected according to the location and length of the stricture, local tissue conditions, complications, and so on.