超声引导下经会阴穿刺活检在前列腺癌诊断中的价值

目的：探讨超声引导下经会阴道前列腺穿刺活检诊断前列腺癌的价值。方法：对376例临床怀疑前列腺癌患者行直肠腔内超声引导下经会阴前列腺穿刺活检。分3组。A组：184例,为指检前列腺触及结节或前列腺增大、质硬怀疑前列腺癌者;B组：84例,为因前列腺增生行直肠腔内超声检查发现有异常回声区域者;C组：108例,为指检未及明显硬节而血中PSA＞10ng/ml者。结果：3组穿刺活检阳性率分别为44．5％（82／184）,29．8％（25／84）,57．4％（62／108）。结论：直肠腔内超声引导下经会阴穿刺活检取材准确,能清楚显示穿刺针的径路和深度,避免损伤邻近脏器,可重复操作,明显提高穿刺活检的阳性率。     

Echogenic structure of prostatic cancer imaged on radical prostatectomy specimens

Twenty radical prostatectomy specimens were scanned ultrasonically in vitro using a transrectal ultrasonic probe to evaluate the ultrasonic pattern of prostatic cancer. Histological and ultrasonic findings of the same areas were compared. No ultrasonic pattern specific for intracapsular prostatic cancer was found. Most often (in 40% of cases) the areas of prostatic cancer appeared hypoechoic on the ultrasonograms. In 30% of cases the carcinoma had a hyperechoic or mixed ultrasonic pattern, and in 30% the echo structure of the prostate was fairly uniform; intracapsular cancer could not be detected ultrasonically in these latter cases. The lack of a specific ultrasonic pattern for intracapsular prostatic carcinoma reduces the value of transrectal ultrasonography in detecting early intracapsular cancers. The main value of ultrasonography in patients with prostatic cancer is in the preoperative staging of the disease and in the follow-up of patients.     

Ultrasonic evaluation of prostatic carcinoma

Twenty-four patients with prostatic carcinoma were examined by transrectal ultrasonotomography. Ultrasound could differentiate prostatic cancer from other prostatic diseases. Since ultrasonic diagnosis is noninvasive, safe, and painless, repeated examinations could be performed, and it was useful to follow patients with prostatic carcinoma after treatment.     

Non-prostatic malignant disease mimicking prostatic cancer

Three patients with pelvic tumours (2 cases of pelvic sarcoma and 1 case of metastatic bronchial carcinoma) presented with symptoms and signs suggestive of prostatic carcinoma. Transrectal ultrasonic scanning with perineal biopsy facilitated the diagnosis. The prognosis of pelvic sarcoma was poor following radiotherapy.     

Cyberwand双导管超声吸附碎石治疗特殊人群膀胱结石

目的 探讨应用Cyberwand双导管超声吸附碎石系统治疗特殊人群膀胱结石的价值.方法 2008年7月～ 2011年10月我院收治因各种原因需长期留置膀胱造瘘管致膀胱结石形成患者89例,其中神经源性膀胱49例,前列腺增生不能耐受手术行膀胱造瘘者14例,肿瘤局部浸润行尿流改道者1 1例,反复尿道狭窄手术失败保留造瘘者15例.均通过膀胱造瘘口肾镜应用Cyberwand双导管超声吸附碎石. 结果 所有手术均顺利完成,手术时间平均40(30～70)min.无膀胱穿孔、大出血、结石残留、输尿管开口损伤等.所有患者均获随访,平均6(1 ～24)个月.13例患者术后7个月再发膀胱结石,再次行上述处理,结石清除干净. 结论 对于各种原因需长期留置膀胱造瘘管的患者所形成的膀胱结石,通过造瘘口Cyberwand双导管超声吸附碎石,效果良好,创伤轻微,具有很好的推广价值.     

Ultrasonic evaluation of the prostatic nodule

Prostatic nodules detected on rectal examination of 50 patients were evaluated by the usual means and by prostatic ultrasonic scanning. Nodules were characterized as being either malignant, benign, inflammatory or stones. Those patients without evidence of calcification on radiography underwent prostatic biopsy and the histological findings were compared to the ultrasonic study. All histologically confirmed malignancies were diagnosed preoperatively and there were no instances of falsely negative ultrasonic studies.     

前列腺移行区的超声观测

为了解前列腺移行区在前列腺各疾病中的形态特征，采用经直肠超声断层法观测了２８０例不同年龄、不同前列腺疾病的移行区形态特征及大小变化，发现：①正常前列腺的移行区最易辨认，位于腺体中央偏前方，呈椭圆形稍低回声暗区，比周边区回声弱。前列腺炎和前列腺癌的移行区变化不大。前列腺增生症表现为移行区扩大，回声增强，边缘模糊，与周边区不易分清。单纯前列腺结石的移行区不扩大，合并前列腺增生症时，移行区扩大。②各年龄     

Diagnosis and staging of prostatic cancer by transrectal ultrasonography. A preliminary study.

Sixty men (7 normal, 53 with prostatic disease) underwent transrectal ultrasonic scanning of their prostates in order to assess the technique and evaluate its reliability in the detection and staging of prostatic cancer. The prostatic capsule was clearly seen in 58 men; non-integrity of the capsule occurred only in those with proven cancer (17 cases). An ultrasound diagnosis of cancer was made for 32 of 33 men with proven disease and it was shown that ultrasound demonstrated anterior perforations of the capsule in 6 out of 18 men with tumours that had been judged by rectal palpation to have been confined to the prostate. It is concluded that transrectal ultrasound is a promising technique of imaging the prostate, particularly in relation to selection of patients for biopsy and for checking staging of cancer carried out by digital assessment of the prostate.     

尿路内翻性乳头状瘤151例临床分析

目的探讨尿路内翻性乳头状瘤的临床表现、病理类型及临床诊治方法。方法回顾性分析1992年3月至2003年9月,我院收治尿路内翻性乳头状瘤151例,其中男134例、女17例,平均年龄54岁。临床表现主要为无痛性肉眼血尿。诊断依据泌尿系B超、尿路造影、膀胱镜检及病理检查。上尿路7例,除1例行肿瘤局部切除外余行患侧肾、输尿管全长切除术。下尿路144例,行经尿道膀胱肿瘤切除(TURBT)124例,其中11例合并良性前列腺增生者同时行经尿道前列腺切除术,前列腺部尿道肿瘤电切3例,膀胱部分切除术15例,膀胱全切术2例。结果118例随访1～12．5年,平均6．3年。5例膀胱内复发,其中2例分别于术后8,30个月发生恶变,行膀胱全切治疗。结论尿路内翻性乳头状瘤是良性肿瘤,多见于男性,好发于膀胱,TURBT是膀胱内翻性乳头状瘤的首选治疗方法。预后良好,但需定期随访。     

Laparoscopic excision of prostatic utricles in children

OBJECTIVE: To report our experience of laparoscopic excision of symptomatic prostatic utricles in children. PATIENTS AND METHODS: Prostatic utricles were excised laparoscopically in four boys (mean age 6.3 years, range 1.5-17). Cysto-urethroscopy and cannulation of the prostatic utricle was initially undertaken with a cystoscope that was left in situ inside the prostatic utricle to facilitate subsequent identification and mobilization during the laparoscopic procedure. Laparoscopy was conducted via a 5-mm port inserted through a supra-umbilical incision. Two more 5 mm working ports were inserted at the right and left mid-abdomen. The prostatic utricle was easily identified with the guidance of cystoscopic transillumination. Dissection was further facilitated by lifting and counter-traction of the prostatic utricle using the indwelling cystoscope. The prostatic utricle was completely mobilized and divided at its confluence with the urethra using an ultrasonic scalpel. RESULTS: Laparoscopic excision of the prostatic utricle was successful in all four patients. The urethral defect was closed by intracorporeal suturing in three patients while the defect was small enough to be adequately closed by ultrasonic coagulation in one. One patient also had a nonfunctioning dysplastic kidney associated with an ectopic ureter joining into the prostatic utricle, and underwent nephroureterectomy at the same setting. The mean (range) operative duration was 148 (105-225) min. All four patients recovered uneventfully with no complications. CONCLUSIONS: Laparoscopic excision under cystoscopic guidance is effective for symptomatic prostatic utricles, offering a good surgical view and allowing easy dissection in a deep and narrow pelvic cavity.     

前列腺特异性抗原密度对前列腺癌骨转移诊断意义的回顾性研究

对２６例病理学、ＣＴ及ＥＣＴ确诊之前列腺癌腺外或骨转移病人术前、术后ＰＳＡ、ＰＳＡＤ作了回顾性研究，同时测定３０例良性前列腺增生症病人作为对照。结果：２６例患者术前ＰＳＡＤ平均值为２．４１，大于２．４１者１９例，占７３．０８％，以０．１作为标准值，则２５例为阳性，占９６．１５％。而对照组大于０．１者３例，假阳性率１０％，大于０．２者２例，假阳性率６．６７％。结果表明ＰＳＡＤ对前列腺疾病的诊断价值优于ＰＳＡ，是早期筛选诊断和监测前列腺癌的治疗效果的有效指标。     

Transrectal ultrasonic volume determination of the prostate--a preoperative and postoperative study

A technique for transrectal ultrasonic volume determination of the prostate, based on the principle of serial planimetry, is presented. The preoperative ultrasonic determinations in 75 cases have been compared to the estimation of size by digital palpation and to the amount of tissue removed at operation. Scannings 6 to 10 weeks postoperatively have shown variable amounts of residual prostatic tissue. The difference in the preoperative and postoperative ultrasonic volume has been compared to the amount of tissue resected at operation, and the accuracy of the method has been established. The transrectal approach gives a close and complete view of the prostate, and has proved to be a simple, easily applicable and reliable method for volume determination. Postoperative scannings show morphological changes in the resection cavity, which are difficult to explain from scanning alone.     

BPH患者中淀粉样变发生情况及临床特征

目的:探讨BPH患者中淀粉样变的发生情况及临床特征,揭示淀粉样变在BPH发生、发展过程中所起的可能作用。方法:采用刚果红染色方法,检测2009~2011年136例在我院行TURP切除标本中淀粉样变的发生情况,分析其与年龄、前列腺体积及其他前列腺疾病的相关性。结果:BPH患者中淀粉样变总阳性表达率为58.8%(80/136)。随着年龄增长,前列腺淀粉样变阳性率显著增加(P0.05),前列腺淀粉样变阳性率与前列腺体积无相关性(P0.05);淀粉样变阳性患者中无伴发前列腺癌(PCa)者,而淀粉样变阴性患者中8.9%(5/56)伴发PCa,二者之间差异有统计学意义(P0.05)。淀粉样变阳性患者中5.0%(4/80)伴发组织学前列腺炎,阴性患者中5.4%(3/56)伴发组织学前列腺炎,二者之间无统计学意义(P0.05)。结论:BPH中淀粉样变发生率随着年龄的增长而增加,但与前列腺体积无关,伴有淀粉样变的BPH中未发现恶性肿瘤,BPH中淀粉样变的发生与是否伴发前列腺炎无相关性。     

Relationship of ultrasonic and histologic findings in benign prostatic hyperplasia

We compared the ultrasonic and histologic findings in 25 patients with benign prostatic hyperplasia (BPH) who underwent retropubic subcapsular prostatectomy. Preoperative ultrasonograms showed a fine echogenic pattern in one case, a rough echopenic pattern in four cases, and a combination of these patterns in 20 cases. In cases exhibiting a mixed pattern, we analyzed each region individually. Ultrasonic and histologic findings were compared in a total of 45 regions. In the 21 regions with a fine echogenic pattern, 14 regions corresponded to those with complicated hyperplastic glands, one region with small cystic atrophic glands, and six regions with a mixture of the two types on histology in observation. In the 24 regions with a rough echopenic pattern, 20 regions corresponded to those with large cystic atrophic glands and an equal volume of large and small cystic atrophic glands were found in the other four. Thus, the echogenic structures observed in patients with BPH were determined by the presence of complicated hyperplastic glands and small cystic atrophic glands. © 1996 Wiley-Liss, Inc.     

Clinical evaluation of inside echo patterns in gray scale prostatic echography

Improved gray scale echograms in transrectal ultrasonography clearly can visualize the anatomical structure of and pathological changes in the prostatic gland. This study includes the classification of ultrasonic findings from the prostatic gland into acoustical pattern groups--solid, cystic and mixed--as well as into pathological-anatomical pattern groups--internal gland, external gland, nodule, stone and miscellaneous. The diagnostic accuracy of prostatic diseases using pattern analysis of prostatic inside echoes was 89 per cent, a 9 per cent improvement over that provided by conventional display.     

The long-term influence of vasectomy on prostatic volume and morphology in man

During the past two decades several papers have described the changes in prostatic secretory capacity following vasectomy. Based upon results indicating a reduction of secretory function, it was suggested that even prostatic size and the incidence of benign prostatic hyperplasia (BPH) might be altered after the operation. In this study, which included 56 males who had been vasectomized 8 years previously and 56 age-matched control persons, transrectal ultrasonic scanning of the prostate was used for exact measurements of the prostatic volume and for the investigation of intraprostatic echo pattern. The total prostatic volume, the volume of the periurethral gland, and the volume of the peripheral zone were not influenced by the vasectomy; nor was the growth rate of these zones affected. In the vasectomy group, the frequency of adenomatous prostates was 19.6%, whereas 30.3% of prostates in the control group had ultrasonic signs of BPH. However, this is not a statistically significant difference. Subdividing the material according to age did not reveal altered BPH frequency in any age group when vasectomized and controls were compared.     

Reproducibility of measurement of prostatic volume by ultrasound. Comparison of transrectal and transabdominal methods

88 men undergoing elective prostatectomy were investigated by transrectal and transabdominal ultrasound. A repeat examination was performed by a second observer in 28 patients. The aims were to determine the correlation between transrectal and transabdominal ultrasonic estimation of prostatic volume and the degree of observer error. Transabdominal estimation of prostatic volume correlated well with the transrectal method (p less than 0.001) and good agreement between the two observers was found with both methods (p less than 0.001). In the individual patient, however, a wide variation in prostatic volume was found between the two observers and the two methods.     

Exfoliative cytology of prostatic carcinoma using a prostatic fluid collecting catheter

In 152 patients who were suspected to have prostatic disease prostatic fluid obtained by a specially designed catheter was examined cytologically. Cytology was positive in 16 of 20 patients who initially were diagnosed clinically as having prostatic carcinoma, in 10 of 41 patients with suspected carcinoma and in 3 of 91 patients with clinical prostatic hypertrophy or other benign diseases. All but one of these cytologically positive cases finally were confirmed histologically to have prostatic carcinoma. In 4 patients initially diagnosed as having prostatic carcinoma cytology was not positive but in one the initial clinical diagnosis was incorrect and only 3 were false negative. This method of diagnosis is simple and highly effective in detecting prostatic carcinoma.     

Paneth cell-like change of the prostate gland. A histological, immunohistochemical, and electron microscopic study.

Paneth cell-like change (PCLC) of the prostatic glandular epithelium was focally observed in one case of normal glandular epithelium, two cases of glandular and stromal hyperplasia, one case of prostatic intraepithelial neoplasia, and four cases of prostatic adenocarcinoma. The distinctive cells were characterized by bright, eosinophilic cytoplasmic granules on routine hematoxylin and eosin-stained material. The cytoplasmic granules in the benign prostatic epithelium were periodate-Schiff's procedure (PAS)-positive and diastase resistant and immunohistochemically negative for lysozyme, neuron-specific enolase, chromogranin, and serotonin. The eosinophilic granules in the prostatic intraepithelial neoplasia and adenocarcinoma cases were immunohistochemically positive for chromogranin, serotonin, and neuron-specific enolase, and negative for lysozyme. By electron microscopy the eosinophilic granules represented exocrine-like or lysosomal-like vesicles in the benign epithelium and neuro-endocrine granules in the malignant epithelium. The lesion represents a prostatic epithelial PCLC rather than a Paneth cell metaplasia. PCLC is the common histological manifestation of two different phenomena: (a) a PAS-positive and diastase-resistant eosinophilic cytoplasmic granular change in benign prostatic epithelium, and (b) endocrine differentiation with neuroendocrine granules in dysplastic and malignant prostatic epithelia. The importance of recognizing PCLC lies in its differentiation from other possible prostatic cytoplasmic inclusions.     

Serum acid phosphatase levels following prostatic massage (author's transl)]

We find an elevation of serum acid phosphatase levels 5 min after prostatic massage in only 10% of patients with prostatic adenoma. This increase is caused by stored prostatic secretion being pressed into the blood vessels. 60 min later these serum levels decrease. With some other patients a slower increase of phosphatase levels occurs; this increase, however, lasts for hours. This kind of increase is caused by prostatic fluid being forced into the interstitium where it is slowly absorbed. A combination of both kinds leads to a curve with two peaks; this could be demonstrated in two cases. No difference was seen in reaction of total acid phosphatase and prostatic phosphatase levels. The increase of phosphatase levels following prostatic massage was no sign of prostatic carcinoma.