腹膜外保留骶前神经对低龄前列腺癌根治术患者勃起功能、精子质量、性生活质量及排尿功能的影响

目的:探讨腹膜外保留骶前神经对低龄前列腺癌根治术患者勃起功能、精子质量、性生活质量及排尿功能的影响。方法:选择2012年1月至2015年12月本院收治的前列腺癌患者80例,按照随机数字法分为两组,各40例,对照组实施常规手术治疗,观察组注重术中行腹膜外保留骶前神经保护,比较手术前后IIEF-5评分、两组术后精液常规及DFI指数、两组术后3月性功能相关指标及两组术后尿动力学检查结果。结果:术后观察组IIEF-5评分优于对照组(P0.05),观察组精子密度、精子活动率及活力均优于对照组(P0.05),且DFI指数小于对照组(P0.05);术后随访3月时,观察组出现性欲增强及勃起功能增强比例大于对照组(P0.05),出现勃起功能障碍比例低于对照组(P0.05);观察组最大尿流量显著大于对照组(P0.05),膀胱顺应性显著优于对照组(P0.05),最大逼尿肌压力及最大尿道压力均显著高于对照组(P0.05)。结论:低龄前列腺癌根治术术中注重行腹膜外保留骶前神经处理,能有效减少手术对患者术后性功能及排尿功能影响,提高术后精子质量及性生活质量。     

认知行为护理对腹腔镜下前列腺癌根治术后勃起功能的影响分析

目的 探讨认知行为护理对腹腔镜下前列腺癌根治术后患者勃起功能的干预效果。方法 选取2020年9月至2022年3月广州市第一人民医院收治的60例拟行腹腔镜下前列腺癌根治术的患者作为研究对象。根据护理类型分为对照组(采用常规护理)和观察组(采用认知行为护理),各30例。观察两组手术前、术后1个月、术后3个月国际勃起功能问卷表-5(IIEF-5)评分、焦虑自评量表(SAS)评分变化,评估认知行为护理对勃起功能的影响。结果 手术前,两组SAS、IIEF-5评分比较,差异无统计学意义(t=0.713、0.875,P>0.05)。术后1个月,观察组SAS评分为(48.91±6.31)分,低于对照组的(55.52±5.83)分,差异具有统计学意义(t=7.968,P=0.000);术后3个月,观察组SAS评分为(39.38±6.41)分,低于对照组的(50.72±5.69)分,差异具有统计学意义(t=10.879,P=0.000)。术后1个月,观察组IIEF-5评分为(13.17±4.22)分,高于对照组的(9.95±3.65)分,差异具有统计学意义(t=4.518,P=0.002);术后3个...     

保留膀胱颈完整性对低龄经尿道前列腺等离子电切术勃起功能及性生活质量的影响

目的:探讨保留膀胱颈完整性对低龄经尿道前列腺等离子电切术勃起功能及性生活质量的影响。方法:选择2011年1月至2015年3月本院收治的良性前列腺增生患者80例,按照随机数字法分为两组,各40例,观察组实施经尿道前列腺等离子电切术,并在术中做好膀胱颈完整性的保护;对照组实施经尿道前列腺等离子电切术,但在术中对膀胱颈三角进行切除,随访6个月,比较两组手术相关并发症、两组不同时间点IIEF-5评分、两组术后6个月性功能相关指标及干预后精液常规及DFI指数变化情况。结果:观察组出现阴茎海绵体神经损伤、周围组织损伤及膀胱颈完整性受损的比例显著高于对照组(P0.05),术后3个月和术后6个月,观察组IIEF-5评分高于对照组(P0.05),观察组性欲增强及勃起功能增强的比例显著高于对照组(P0.05),出现逆行射精的比例显著低于对照组(P0.05),干预后观察组精液中精子密度、精子活动率及精子活力均显著高于对照组(P0.05),且精子DNA碎片显著少于对照组(P0.05)。结论:经尿道前列腺等离子电切术保留膀胱颈完整性能显著减少患者术后勃起功能障碍,提高性生活质量,同时还能提高精子质量。     

不同直肠癌手术术式男性患者术前术后勃起功能状况调查分析

目的:探讨不同直肠癌手术术式对男性患者术前术后勃起影响,以期提高临床诊治水平。方法:选取2010年2月至2014年2月176例直肠癌患者为研究对象,分成两组,对照组88例,予开腹直肠癌根治术,观察组88例,予腹腔镜治疗,观察治疗前后在勃起及射精功能的变化情况。结果:在勃起和射精功能上,术前比较差异无统计学意义(P0.05),对照组治疗后6个月、12个月和治疗前比较射精功能均有下降,但治疗后6个月与治疗前后比较差异无统计学意义,治疗后12个月和治疗前比较差异有统计学意义(P0.05),观察组治疗前和治疗后6个月、12个月比较差异无统计学意义(P均0.05);对照组治疗后6个月、12个月较治疗前IIEF-5评分有下降,治疗前后比较差异有统计学意义(P均0.05),观察组治疗前和治疗后6个月、12个月IIEF-5评分比较差异无统计学意义(P均0.05),治疗后6个月、12个月两组IIEF-5评分比较差异有统计学意义(P0.05)。对两组治疗前后射精功能进行比较,术前比较差异无统计学意义(P0.05)。结论:腹腔镜根治术对直肠癌术后性功能影响性较低,总体上能改善生活质量。     

腹腔镜前列腺癌根治术的疗效及对患者术后性功能的影响

目的:探讨腹腔镜前列腺癌根治术的疗效及对患者术后性功能的影响。方法:选取2015年1月至2016年1月我院住院治疗的腹腔镜前列腺癌根治术患者26例,设立为腹腔镜组,另选择2014年1月至2015年1月在我院住院治疗的行经耻骨后前列腺癌根治术22例作为对照组,比较两组患者的术中出血量、术后肠功能恢复时间、住院时间及VAS评分,以及术前术后性功能IIEF-5评分、术后阴茎勃起功能障碍发生率。结果:腹腔镜组患者术中出血量(421.6±32.3)mL,术后肠功能恢复时间(3.2±1.2)h,术后住院时间(10.5±2.3)d,术后VAS评分(2.3±0.8)分,上述指标与对照组比较,组间差异存在显著性(P0.05)。腹腔镜组与对照组术前IIEF-5评分比较,差异不显著(P0.05),术后1年,腹腔镜组术后性功能IIEF-5评分为(23.6±2.3)分,显著低于对照组,组间差异具有显著性(P0.05)。腹腔镜组术后阴茎勃起功能障碍发生率7.7%(2/26),对照组为26.9%(7/26),两组组间比较差异具有显著性(P0.05)。结论:腹腔镜前列腺癌根治术疗效确切,能够减少术中出血量、缩短住院时间,患者痛苦少,显著降低患者术后勃起功能障碍的发生率,使患者获得更好的性生活质量。     

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。     

腹腔镜直肠癌根治术中保留Denonvilliers筋膜对男性性功能的影响研究

目的:观察腹腔镜直肠癌根治术中保留Denonvilliers筋膜对男性性功能影响性。方法:收集2010年5月至2015年1月106例男性直肠癌患者临床资料,均予腹腔镜直肠癌根治术治疗,根据术中是否保留Denonvilliers筋膜分成两组,每组53例,观察不同方式对男性性功能和排尿功能影响性。结果:排尿功能上,治疗后对照组自由尿流率、排尿量较治疗前显著下降,残尿量显著升高(P0.05),研究组治疗前后比较差异不显著(P0.05),治疗后研究组显著优于对照组(P0.05);性功能上,对照组术后6个月、术后12个月勃起功能障碍率分别为24.53%、16.98%,射精障碍率为24.53%、15.09%,研究组术后6个月、术后12个月勃起功能障碍率分别为9.44%、7.55%,射精障碍率为9.44%、5.66%,研究组显著低于对照组(P0.05)。结论:腹腔镜直肠癌根治术中保留Denonvilliers筋膜能降低对男性性功能影响性。     

前列腺癌根治术联合盆腔淋巴结清扫术治疗前列腺癌对性功能影响的回顾性研究

目的 探究前列腺癌根治术联合盆腔淋巴结清扫术治疗前列腺癌对其性功能的影响。方法 回顾性分析2015年5月至2020年5月余姚市人民医院诊治的63例行前列腺癌根治术联合盆腔淋巴结清扫术治疗的前列腺癌患者的临床资料。根据治疗方式分为常规组(n=32)和改良组(n=31),分析比较两组围手术期情况,采用国际勃起功能指数-5(IIEF-5)评估术后患者性功能恢复情况,采用国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)评估术后患者控尿功能。结果 改良组手术时间长于常规组,术中出血量少于常规组,术后肠道功能恢复时间和留置导尿管时间短于常规组,差异均具有统计学意义(P<0.05)。两组术前IIEF-5、ICI-Q-SF评分比较,差异无统计学意义(P>0.05);改良组术后3、6、12个月的IIEF-5评分均高于常规组,改良组术后3、6、12个月的ICI-Q-SF评分均低于常规组,差异均具有统计学意义(P<0.05)。结论 改良式腹腔镜下前列腺癌根治术联合盆腔淋巴结清扫术对前列腺癌患者的性功能和控尿恢复能力优于传统腹腔镜下前列腺癌根治术联合盆腔淋巴结清扫术。     

腹腔镜前列腺癌根治术的疗效观察及对性功能的影响

目的:分析腹腔镜前列腺癌根治术治疗前列腺癌的临床疗效以及对性功能的影响。方法:选取中国人民解放军187医院2013年5月至2017年6月收治的前列腺癌患者280例,采用随机化列表分为对照组和观察组,每组140例,对照组患者采用传统的开放性前列腺癌根治术进行治疗,观察组患者实施腹腔镜前列腺癌根治术治疗,观察并比较两组患者的手术情况、IPSS评分、尿流动力学指标、控尿率、性功能以及并发症等相关指标。结果:观察组患者在手术时间、术中出血量、引流管留置时间以及住院时间均低于对照组,差异具有统计学意义(P 0. 05);术后6个月,观察组的Qmax、PVR和IPSS评分均优于对照组,差异具有统计学意义(P 0. 05);观察组的控尿率和保留性功能者比率均高于对照组,且逆行射精率低于对照组,差异具有统计学意义(P 0. 05);术前,两组患者的IIEF-5评分无统计学差异(P 0. 05);术后6个月,观察组的IIEF-5评分高于对照组,差异具有统计学意义(P 0. 05);观察组并发症的总发生率低于对照组,差异具有统计学意义(P 0. 05)。结论:腹腔镜前列腺癌根治术能够减少手术时间和术中出血量,改善患者尿流动力学,改善性功能,降低术后并发症发生率,减少引流管留置时间和住院时间,值得临床上推广使用。     

西地那非与益肾壮阳膏治疗前列腺术后勃起功能障碍的疗效观察

目的:对比研究西地那非单纯用药和西地那非与益肾壮阳膏联合用药,在治疗前列腺癌根治术后勃起功能障碍中的临床疗效及药物安全性。方法:本研究纳入前列腺癌根治术后勃起功能障碍的男性患者90例,随机1:1对照分为实验组和治疗组,全部患者于性生活开始前1小时~2小时内服用50mg西地那非,并根据用药效果调整剂量至25mg或100mg。实验组患者增加益肾壮阳膏外用涂抹于会阴及阴囊两侧,每日睡前一次。对比两组患者治疗6个月后IIEF-5调查结果评分、平均西地那非用药量和治疗满意度。结果:实验组与对照组患者在治疗6个月后,IIEF-5评分有明显提高,治疗前后评分差异具有统计学意义(P0.05);与对照组相比,实验组患者IIEF-5评分问题4,维持勃起和问题5性交满足感方面,明显好于对照组患者,且组间差异具有统计学意义(P0.05),实验组患者西地那非平均用药量为32.5±7.43mg/次,明显低于对照组患者57.9±8.23 mg/次,其不良反应发生次数仅为8.9%,明显低于对照组24.4%,组间差异具有统计学意义(P0.05)。结论:西地那非单纯用药和西地那非与益肾壮阳膏联合应用,对前列腺癌根治术后勃起功能障碍都具有良好的临床疗效,联合应用益肾壮阳膏可以降低西地那非服药量、提高患者维持勃起和性交满意度、提高治疗满意度并降低不良反应发生率。临床效果显著,值得推广应用。     

New fillers for the new man

ABSTRACT:  Two new collagen-based lidocaine-containing dermal fillers, ArteSense™/ArteFill™ (Artes Medical, San Diego, CA) and Evolence® (Colbar LifeScience Ltd., Herzliya, Israel), have proved to be of particular interest to men, many of whom seek a long-lasting or permanent correction. ArteFill™ has been available in the United States since 2006, and it is expected that Evolence® will reach the American market in 2008. The properties of the two products will be described, and experience based on the administration of many hundreds of syringes of both products by a Canadian dermatologist will be detailed here, with tips and precautions to optimize patient outcomes.     

Outcomes and adverse effects of ablative vs nonablative lasers for skin resurfacing: A systematic review of 1093 patients

It is generally believed that ablative laser therapies result in prolonged healing and greater adverse events when compared with nonablative lasers for skin resurfacing. To evaluate the efficacy of ablative laser use for skin resurfacing and adverse events as a consequence of treatment in comparison to other modalities, a PRISMA‐compliant systematic review (Systematic Review Registration Number: 204016) of twelve electronic databases was conducted for the terms “ablative laser” and “skin resurfacing” from March 2002 until July 2020. Studies included meta‐analyses, randomized control trials, cohort studies, and case reports to facilitate evaluation of the data. All articles were evaluated for bias. The search strategy produced 34 studies. Of 1093 patients included in the studies of interest, adverse events were reported in a total of 106 patients (9.7%). Higher rates of adverse events were described in nonablative therapies (12.2% ± 2.19%, 31 events) when compared with ablative therapy (8.28% ± 2.46%, 81 events). 147 patients (13.4%) reported no side effects, 68 (6.22%) reported expected, transient self‐resolving events, and five (0.046%) presented with hypertrophic scarring. Excluding transient events, ablative lasers had fewer complications overall when compared with nonablative lasers (2.56% ± 2.19% vs 7.48% ± 3.29%). This systematic review suggests ablative laser use for skin resurfacing is a safe and effective modality to treat a range of pathologies from photodamage and acne scars to hidradenitis suppurativa and posttraumatic scarring from basal cell carcinoma excision. Further studies are needed, but these results suggest that ablative lasers are a superior, safe, and effective modality to treat damaged skin.     

Genetic alterations in RAS‐regulated pathway in acral lentiginous melanoma

Studies integrating clinicopathological and genetic features have revealed distinct patterns of genomic aberrations in Melanoma. Distributions of BRAF or NRAS mutations and gains of several oncogenes differ among melanoma subgroups, while 9p21 deletions are found in all melanoma subtypes. In the study, status of genes involved in cell cycle progression and apoptosis was evaluated in a panel of 17 frozen primary acral melanomas. NRAS mutations were found in 17% of the tumors. In contrast, BRAF mutations were not found. Gains of AURKA gene (20q13.3) were detected in 37.5% of samples, gains of CCND1 gene (11q13) or TERT gene (5p15.33) in 31.2% and gains of NRAS gene (1p13.2) in 25%. Alterations in 9p21 were identified in 69% of tumors. Gains of 11q13 and 20q13 were mutually exclusive, and 1p13.2 gain was associated with 5p15.33. Our findings showed that alterations in RAS‐related pathways are present in 87.5% of acral lentiginous melanomas.     

Self‐resolving superficial primary cutaneous mucormycosis in a 7‐week‐old infant

A 7‐week‐old girl, born at 30 weeks' gestational age, presented to clinic for evaluation of a crop of vesicular lesions that were noted after removal of a bandage that had been in place for 4 days. A punch biopsy of the lesion revealed fungal elements that were later identified as Rhizopus spp. The lesion began to self‐resolve, and no further treatment was needed, with full resolution of the lesion by 1 month after presentation. Clinicians should be aware of the variable presentations of mucormycosis and consider fungal infection in the differential diagnosis when evaluating vulnerable patients with skin eruptions.     

Multiple New-Onset Subcutaneous Nodules of the Upper Extremity Digits: Giant Cell Tumor of Tendon Sheath and Lipoma

A black woman with the concurrent onset of two subcutaneous nodules located on the digits of her upper extremities is described. Initially, a single systemic disorder was considered; yet, the lesions differed in morphology and consistency. Microscopic examination of the nodules showed a giant cell tumor of tendon sheath and a lipoma. Although Occam's “razor” suggests that multiple lesions in the same person are more likely to represent variable manifestations of a single disorder than several different diseases in that individual, the simultaneously appearing lesions in this patient represented two different conditions.