负压勃起装置联合西地那非治疗前列腺癌根治术后阴茎勃起功能障碍的临床研究

目的:研究前列腺癌根治术后阴茎勃起功能障碍的临床诊断与治疗方法。方法:回顾性分析2014年1月至2015年1月间我院和宜昌市中心人民医院入院行前列腺癌根治术切术后并发勃起功能障碍(ED)的患者64例,根据随机数表法将其分为治疗组(32例)与对照组(32例)。对照组应用西地那非治疗,治疗组在其基础上应用负压勃起装置(VED),疗程均为3个月。观察比较治疗前后两组患者勃起功能国际问卷-5(IIEF-5)评分、阴茎长度与周径、阴茎勃起硬度等指标,同时观察两组不良反应。结果:治疗组治疗后IIEF-5评分为(13.18±2.27)分,对照组则为(9.43±1.84)分;与对照组相比,治疗组改善显著(P0.05)。治疗组显效10例(31.25%)、显效15例(46.88%)、总有效率为100.00%,对照组痊愈3例(9.38%)、显效10例(31.25%)、总有效率为78.13%;两组差异显著(P0.05)。两组患者治疗前阴茎长度与周径并无显著差异,治疗后均有不同程度的改善,以治疗组较为显著(P0.05)。与对照组相比,治疗组阴茎长度与周径均显著较长(P0.05)。治疗前两组患者的阴茎勃起硬度无显著差异,治疗后两组均显著的改善(P0.05);且与对照组相比,治疗组改善更为显著(P0.05)。两组患者均有2例出现皮肤潮红与头痛,均较轻微,不影响继续服药;治疗组1例阴茎皮肤发暗,1例阴茎性交僵硬麻木,指导患者降低负压压力后症状消失。结论:前列腺癌根治术后阴茎勃起功能障碍的诊断应结合患者的病史、体格检查、心理状态等进行综合分析,对患者在应用西地那非的基础上联用负压勃起装置可有效改善患者的阴茎长度、周径与硬度,提高IIEF-5评分。     

经耻骨后与腹腔镜前列腺癌根治术治疗早期局限性前列腺癌的疗效观察

目的:比较经耻骨后前列腺癌根治术与腹腔镜前列腺癌根治术治疗早期局限性前列腺癌的临床疗效。方法:选择2011年2月至2014年2月在我院泌尿外科行前列腺癌根治术的42例前列腺癌患者进行研究。根据手术方式不同分为腹腔镜手术组(19例)和经耻骨后手术组(23例)。比较两组患者的术前基本资料、手术时间以及术后住院天数。结果:腹腔镜组患者的术中出血量显著少于经耻骨后组、导尿管放置时间以及住院时间均显著短于经耻骨后组,但腹腔镜手术时间长于经耻骨后手术组,差异均有统计学意义(均P0.05)。两组患者在生化复发率、完全尿控率比较无统计学意义(P0.05)。结论:腹腔镜前列腺癌根治术治疗早期局限性前列腺癌,其疗效与经耻骨后前列腺根治术疗效相当,且具有手术创伤小、出血少、恢复快等优点,值得临床推荐。     

Cavernous nerve interposition grafting during radical prostatectomy

Erectile dysfunction remains a troublesome complication after radical prostatectomy, with detrimental effects on patient quality of life. The extent to which cavernous nerves are spared during surgery can significantly affect post-radical prostatectomy erectile function. For patients with significant local disease, resection of one or both cavernous nerves may be necessary to achieve cure. The technique of cavernous nerve grafting has been developed to restore nerve continuity and function in such instances. This review article summarizes the theory, technique, outcomes, and new developments in the area of cavernous nerve grafting during radical prostatectomy.     

探讨临床T4期前列腺癌新辅助内分泌治疗后行腹腔镜下前列腺癌根治术的临床研究

目的探讨采用新辅助内分泌(NHT)治疗临床T4期前列腺癌最佳方案及在此之后行腹腔镜下前列腺癌根治术的临床应用价值。方法选取2015年1月至2018年12月南京医科大学附属淮安第一医院诊治的60例T4期前列腺癌患者临床资料作为研究对象。将行3个月～9个月NHT治疗后联合腹腔镜下前列腺癌根治术患者设为观察组(30例),接受穿刺检查后6周～8周行腹腔镜下前列腺癌根治术患者设为对照组(30例),比较两组患者基本临床特征及围手术期并发症情况。结果 NHT治疗后观察组患者PSA降低至0.01 ng/mL～7.43 ng/mL,PSA(0.99±0.17)ng/mL,与治疗前比较差异具有统计学意义(P0.05)。术后3个月复查观察组患者PSA均低于0.01ng/mL,与对照组患者比较下降明显,差异具有统计学意义(P0.05)。所有病例均经腹腔镜下顺利完成,观察组平均手术时间与平均出血量与对照组差异无统计学意义(P0.05)。观察组术后病理变化与对照组比较,差异具有统计学意义(P0.05);观察组Gleason评分、切缘阳性比例、盆腔淋巴结转移比例、术后并发症发生率与对照组差异无统计学意义(P0.05)。所有患者均获随访,随访时间3个月～30个月,观察组2例出现生化复发,对照组3例出现生化复发,两组均无局部复发及远处转移。结论 NHT治疗后使T4期前列腺癌患者获得手术机会,手术安全、有效。对PSA100 ng/mL、100ng/mLPSA 200ng/mL及PSA200ng/mL的患者大约分别需要4个月、5个月和6个月NHT治疗后适合行手术治疗。     

小剂量他达拉非治疗保留性神经的前列腺癌根治术后勃起功能障碍的探讨

目的：探讨小剂量他达拉非治疗保留性神经的前列腺癌根治术后勃起功能障碍的疗效和安全性。方法：回顾性分析72例保留神经的前列腺癌根治术后患者的临床资料,72例患者分为治疗组37例,每日服用他达拉非5mg 1次;观察组35例,不服药。分别在术前、术后6个月和1年,采用国际勃起功能指数-5对患者进行调查。结果：在术后6个月,治疗组和观察组的IIEF-5总分分别为（9.7±3.2）分和（6.7±3.5）分;在术后1年中,治疗组的IIEF-5总评分为（12.8±6.6）分,显著高于观察组（7.8±2.9）分,差别有统计学意义（P＜0.05）。他达拉非的副作用有面部潮红4例（10.8％）、头痛2例（5.4％）和头晕1例（2.7％）。结论：保留性神经的前列腺癌根治术后,患者每日口服他达拉非5 mg 1次,耐受性良好,与对照组相比,可以起到明显改善勃起功能障碍的效果。     

体质指数对根治性前列腺切除术的影响研究

目的:探讨临床中体质指数对根治性前列腺切除术的临床影响。方法:采取回顾性的方法对我院2011年1月至2012年12月间200例根治性前列腺切除术患者临床资料进行分析,依据腹腔镜与开放手术患者中患者的体质指数分为肥胖组和非肥胖组,观察两组患者的手术指标和术后指标。结果:腹腔镜下根治性前列腺切除术中肥胖组和非肥胖组患者的手术时间、术中出血量、手术前后血清Hb差值比较具有明显的差异(P0.05),统计学有意义。两组留置导尿管时间比较无明显的差异(P0.05),统计学无意义。开放性根治性前列腺切除术中肥胖组和非肥胖组患者的术中出血量、手术前后血清Hb差值比较具有明显的差异(P0.05),统计学有意义。两组手术时间、留置导尿管时间比较无明显的差异(P0.05),统计学无意义。结论:临床中对于开放性根治性前列腺切除术肥胖患者手术中更容易发生失血,在腹腔镜下根治性前列腺切除术肥胖患者较非肥胖患者手术的操作时间长,且更容易发生出血。     

Quantitative and morphologic changes of Langerhans' cells after ultraviolet A irradiation of human epidermis

Three different surface markers (OKT6, HLA-DR, and adenosinetriphosphatase) were compared to identify Langerhans' cells, and the changes in number and morphology of these cells were studied at different intervals after irradiation of human skin by a 2.5-fold minimal erythema dose of ultraviolet A. Morphologic alteration and decreased surface-marker reactivity became evident on day 2 and were most pronounced on day 3 or day 4 (injury phase). The recovery phase started between day 4 and 1 week and was complete by 3 weeks. HLA-DR+/OKT6- (DR+T6-) cells were present at all time intervals. The ratio of these cells to the sum of DR+T6- and DR+T6+ cells was 0.3% before irradiation, reached a peak of 65.4% at day 4, and decreased to 0.6% by 3 weeks.     

负压勃起装置治疗前列腺癌根治术后勃起功能障碍的有效性和安全性研究

目的：探讨前列腺癌根治术（RP）后发生的勃起功能障碍（ED）应用负压勃起装置（VED）治疗的疗效和安全性.方法：2009年3月至2012年12月就诊的14例RP后ED患者随机分为两组,对照组6例,给予西地那非治疗;观察组8例,在服用西地那非的基础上加用Osbon助勃器治疗.比较两组治疗前、治疗3个月后勃起功能国际问卷-5（fIEF-5）评分、阴茎长度和周径、阴茎勃起硬度评分的差异及不良反应发生率.结果：治疗后两组IIEF-5评分均较治疗前提高,但观察组明显高于对照组（P＜0.05）;观察组痊愈、显效、有效和无效例数分别为2例、5例、1例、0例,而对照组为0例、2例、2例、2例,观察组疗效优于对照组（P＜0.05）;治疗后观察组阴茎长度和周径均较治疗前升高,且高于对照组,差异均有统计学意义（P＜0.05）;治疗后两组阴茎勃起硬度分级均较治疗前提高,且观察组明显高于对照组（P＜0.05）;两组不良反应较轻微.结论：RP术后ED患者在口服西地那非治疗基础上进行VED治疗安全有效.     

Rationale for early penile rehabilitation following nerve-sparing radical prostatectomy

Erectile dysfunction is one of the most important quality-of-life issues following radical prostatectomy. The potency rates reported following nerve-sparing technique varies between 40% and 86%, and the time period required for complete recovery of erectile function varies from 6 to 24 months. The literature evidence suggests that lack of natural erections during this period of time produces cavernosal hypoxia. Prolonged periods of cavernosal hypoxia induce fibrosis, which later increases the incidence of venous leak. Recently, interest has grown among the physicians to interrupt these events by preventing cavernosal hypoxia during the period of neuropraxia. Initial studies using intracavernosal injection appear to be beneficial. This article reviews the pathophysiology of cavernosal hypoxia following radical prostatectomy with currently available evidence for the interventions to promote the nerve recovery and regeneration.     

Extraperitoneal robot-assisted radical prostatectomy: Comparison with transperitoneal technique

AIM: To determine peri-operative, oncological, functional and safety profiles of extraperitoneal robot-assisted radical prostatectomy(e RARP) vs transperitoneal robot-assisted radical prostatectomy(t RARP) in a single centre.METHODS: A total of 120 consecutive patients underwent 50 e RARP and 70 e RARP operations respectively by the same surgical team. Peri-operative and post-operative outcomes including blood loss, hospitalization, complications(Clavien grade), positive surgical margin(PSM) rates, continence and erectile function were compared. The performance of e RARP required several technical modifications. These included developmentof Retzius' space by balloon insufflation, laparoscopic dissection of lateral extensions of this area; caudal port positioning; cranial digital stripping of peritoneum for sucker port and lodging the bagged prostate specimen adjacent to the lateral assistant port to permit space for urethro-vesical anastomosis.RESULTS: Robotic console times were shorter with e RARP vs t RARP(145.1 min vs 198.3 min, P 0.0001). There were no significant differences in blood loss, PSM rates(e RARP 17.7% vs t RARP 22%) or complications(e RARP 8.5% vs t RARP 8%). A drain was used in all patients after t RARP and in 25/70 e RARP cases. Length of hospital stay was shorter after e RARP(mean 1.94 d vs 3.6 d, P 0.0002). There were no differences between techniques in continence or potency at 6 mo. e RARP required several technical modifications: development of Retzius' space by balloon insufflation, laparoscopic dissection of lateral extensions of this area; caudal port positioning; and lodging the bagged prostate specimen adjacent to the lateral assistant port to permit space for urethro-vesical anastomosis.CONCLUSION: e RARP demonstrated advantages in surgical times, hospital stay and equivalence in PSM rates, complications and functional outcomes. e RARP is a useful alternative to t RARP especially in patients with adhesions, pre-existing inguinal hernias, or those unable to withstand steep Trendelenburg position.     

护士主导的规范盆底功能训练对根治性前列腺切除术后患者尿控能力的影响

目的探讨护士主导的规范盆底功能训练方案对根治性前列腺切除术(RP)后患者尿控能力恢复的影响。方法选取2018年1月至2020年3月贵州省人民医院泌尿外科收治的110例行RP手术的前列腺癌(PCA)患者作为研究对象,按编号随机分为对照组和试验组(各55例)。对照组予以常规盆底功能训练,试验组予以护士主导的规范盆底功能训练。观察并记录两组患者尿失禁持续时间,记录拔除尿管后即刻、1个月、3个月尿控能力恢复情况,并分析各时段患者焦虑自评量表(SAS)、抑郁自评量表(SDS)及尿失禁问卷表简表(ICI-Q-FS)评分情况。结果试验组尿失禁持续时间为(18.91±30.20)d,显著低于对照组的(34.89±37.56)d(P<0.05);试验组拔除尿管后即刻、1个月、3个月尿控比例明显高于对照组(P<0.05);试验组各时间段的SAS、SDS、ICI-Q-FS评分比对照组更低(P<0.05)。结论在护士主导的规范盆底功能训练下,RP后患者尿控能力恢复更快,尿失禁发生率更低;同时也能减少患者术后焦虑、抑郁的发生率,提高生活质量。     

Penile lichen sclerosus after allogeneic stem cell transplantation

Graft-versus-host disease (GVHD) often complicates allogeneic stem cell transplantation (SCT) and affects mainly the gut, liver, lung and skin. The microscopic morphological features of late-phase sclerodermatous chronic GVHD in the skin, namely epidermal atrophy, lymphoplasmacytic infiltration, dense dermal fibrosis and adnexal atrophy, are histologically indistinguishable from those in sporadic systemic sclerosis, morphoea and the related condition of lichen sclerosus. Mucosal orifices including those of the genitourinary system may be severely affected. We present three SCT recipients with chronic GVHD and severe posthitis leading to phimosis requiring surgery. The excised prepuces showed features of lichen sclerosus including epidermal atrophy and a subepidermal zone of eosinophilic, homogeneous and hyalinized collagen above a band-like lymphoplasmacytic infiltrate. These cases add further evidence to support the notion that penile lichen sclerosus should be included within the expanding sclerodermoid spectrum of late-stage cutaneous chronic GVHD.     

Neuromodulatory drugs for the radical prostatectomy patient: Current and future applications

Prostate cancer is the most common noncutaneous malignancy in US men, with an estimated 232,000 new cases diagnosed in 2005. Radical prostatectomy (RP) has proved to be a safe and effective therapy for localized prostate cancer. However, RP can be associated with some risk of morbidity, which includes a potential compromise in erectile function. Medical therapies for erectile dysfunction after RP include vasoactive agents and neuromodulatory agents. This review evaluates the potential role of neuromodulatory agents in the post-RP patient. The potential of developing an agent that has a high safety profile and long duration of effectiveness makes these agents attractive alternatives for the future.     

Barbed polyglyconate vs monocryl suture in vesico-urethral anastomosis during robot-assisted radical prostatectomy

AIM: To compare outcomes using barbed polyglyconate(V-Loc 180) vs monofilament monocryl suture in forming vesico-urethral anastomosis(VUA) during robot assisted radical prostatectomy.METHODS: Review of prospectively collected robot assisted radical prostatectomy data between July 2011 and September 2012. VUA technique: VUA was performed using 2 cm × 15 cm 2/0 V-Loc 180 continuous sutures or 3/0 monofilament monocryl sutures. Anastomotic integrity was tested intra-operatively with a water leak test. All patients had a post-operative cystogram at day 7 to 10.RESULTS: There were 189 patients in the study with 113 in the V-Loc group and 76 in the monocryl group. Demographics were similar for both groups P 0.05). The median operative time for V-Loc group was 130 min and monocryl group was 145 min, which was statistically significant(P 0.001). The median blood loss for both groups was 200 m L with no significant difference(P = 0.260). The pathology results of the 2 groups were similar(P = 0.537). Four patients in the V-Loc group and two patients in the monocryl group had radiological urinary leak. This was not statistically significant(P = 1.00) and all patients improved with conservative management. The continence rates were comparable for both groups.CONCLUSION: V-Loc suture significantly reduced operative time facilitating ease of VUA formation. Overall functional outcome and urinary morbidity were not significantly different from the monofilament group.     

The morphologic changes in lamellar bodies and intercorneocyte lipids after tape stripping and occlusion with a water vapor-impermeable membrane

It has been reported that artificial restoration of barrier function by a water vapor-impermeable membrane after tape stripping induces barrier abrogation in hairless mice, impeding rather than enhancing barrier recovery. To address this issue, we examined the morphologic changes in the epidermis after tape stripping and occlusion with a water vapor-impermeable membrane in murine skin. Male hairless mice were used for all studies of barrier perturbation and occlusion. Barrier disruption was achieved by repeated application of cellophane tape. Immediately after tape stripping the animals were wrapped in a tightly fitting water vapor-impermeable membrane. Transepidermal water loss (TEWL) was measured 20 min after tape stripping and 14, 24, 36, 48 and 60 h after occlusion. For electron microscopy the samples were treated with osmium tetroxide (OsO ₄ ) or ruthenium tetroxide (RuO ₄ ). When tape-stripped animals were wrapped in a water vapor-impermeable membrane, thereby preventing water flux, barrier function did not recover normally. These results demonstrate that an artificial block to TEWL with an impermeable membrane did not enhance barrier recovery. By electron microscopy many transitional cells and lacunae of various sizes were seen within the intercellular spaces of the stratum corneum after occlusion following tape stripping. Occlusion also caused alterations in both lipid lamellar membrane structures in the stratum corneum interstices and the lamellar bodies in the cytosol of granulocytes and transitional cells. Secreted lamellar body contents also appeared to be abnormal in the stratum corneum-stratum granulosum junction. Received: 17 December 1996 / Accepted: 14 November 1997     

Penile dermatophytosis

Dermatophyte infections of the penis and scrotum are relatively rare compared with those involving the groin. Four cases of penile tinea due to Trichophyton rubrum are described. All patients had associated foci of fungal infection, but only one had crural involvement. Treatment with oral antifungal agents led to complete resolution of penile dermatophytosis.