经尿道钬激光前列腺剜除术(HoLEP)

钬激光前列腺剜除术（holmium laser enucleation of the prostate，HoLEP）可达到与开放手术完全相同的解部学目标，与经尿道前列腺电切术（transurethral resection of the prostate，TURP）金标准相比，特别对前列腺尖部的处理远胜一筹，且更微创、安全、手术时间短、出血少、术后恢复快，因而在近年国外广泛开展。我国于2000年引进这项技术，2001年8月～2005年7月，我们已成功完成1333例手术，现将HoLEP经验总结如下。     

健康教育对钬激光前列腺剜除术后并发症影响的效果评价

目的:探讨健康教育对钬激光前列腺剜除术(HoLEP)后并发症的影响.方法:对40例进行钬激光前列腺剜除术(HoLEP)的患者开展围手术期的健康教育与40例常规护理的钬激光前列腺剜除术的患者进行比较,两组病人在年龄、血清前列腺特异抗原(PSA)、国际前列腺症状评分(IPSS)、生活质量评分(Q0LS)、最大尿流率(Qmax)方面没有显著差异(P＞0.05).结果:开展健康宣教后钬激光前列腺剜除术后并发症的发生率明显下降,与常规护理的钬激光前列腺剜除术的患者比较,有显著差异(P＜0.001).结论:在常规护理的同时加强对钬激光前列腺剜除术患者的健康知识教育,可明显提高前列腺剜除术的治疗效果,减少并发症的发生,从而提高患者的生活质量,增进护患交流,改善护患关系,提高护士自身素质,提高护理的社会效益.     

经尿道前列腺钬激光剜除术日间手术24例临床报告

目的观察经尿道前列腺钬激光剜除术(HoLEP)对于特定患者进行日间手术的安全性及可行性。方法我院于2016年1月25日至2016年5月20日对24例前列腺体积小于60mL、膀胱逼尿肌功能及心肺功能良好的特定前列腺增生(BPH)患者行日间经尿道前列腺钬激光剜除术。所有患者均在术前于门诊行术前检查并进行严格准入评估。术后密切观察患者各项生命体征,于入院后24h内拔除导尿管并进行出院评估,符合出院标准的患者予以出院。术后1周内我院每天对患者进行电话或网络随访,及时了解并记录患者术后一般状况及排尿情况。结果 24例BPH患者均顺利完成日间经尿道前列腺钬激光剜除术(HoLEP),其中23例于24h内顺利拔管出院,术后无明显并发症,1例术后出现发热,体温达38.6℃,未达到日间手术出院标准,予以抗感染治疗及对症治疗后留院观察3d后恢复出院。结论对于前列腺体积小于60mL、膀胱逼尿肌功能及心肺功能良好的特定前列腺增生患者行日间经尿道前列腺钬激光剜除术(HoLEP)安全、可行,可缩短BPH患者拔管及冲洗时间,降低住院天数,减少医疗费用,适合在我国BPH手术技术成熟的大型医院开展。     

经尿道钬激光前列腺剜除术与前列腺电切术近期疗效的对比分析

目的比较前列腺钬激光剜除术(holmium laser enucleation of the prostate,HoLEP)和前列腺电切术(transurethral resection of the prostate,TURP)治疗良性前列腺增生(benign prostatic hyplasia,BPH)的疗效及安全性。方法将2012年6月至2013年7月90例行腔内手术治疗的BPH患者随机分为2组,分别行前列腺钬激光剜除术(HoLEP)和经尿道前列腺电切术(TURP)。监测、记录2组患者围手术期和术后1、3、6个月复查指标,比较最大尿流率(maximum flow rate,Qmax)、国际前列腺症状评分(international prostate symptom score,IPSS)、生活质量评分(quality of life score,QOL)等变化并进行统计学分析,比较两种术式近期临床疗效。结果术前两组患者一般情况和国际前列腺症状评分、生活质量评分、最大尿流率、残余尿量测量以及前列腺重量比较差异无统计学意义(P0.05);HoLEP组较TURP组术中出血量、手术时间、低钠血症的发生率、膀胱冲洗时间、留管时间都较低(P0.01);术后1个月、3个月及6个月2组IPSS、QOL和Qmax均比术前有明显改善(P0.01);但2组间比较并无显著统计学意义(P0.05)。结论 HoLEP术与TURP术相比,近期手术效果相似,且手术安全性更好,可视为治疗BPH的较好新方法。     

HoLEP改良操作对尿失禁与性功能的影响分析

目的 探讨改良保留尿道黏膜经尿道钬激光前列腺剜除术(holmium laser enucleation of prostate,HoLEP)治疗前列腺增生症对尿失禁与性功能的影响分析.方法 回顾性分析2016年2月到2019年6月257例前列腺增生症患者,此257名患者术后均有性生活,122例行保留尿道粘膜的HoLEP...     

良性前列腺增生合并轻度尿道狭窄的治疗

本文回顾性分析我院收治的21例良性前列腺增生(BPH)合并轻度尿道狭窄患者的临床资料。21例行前列腺手术时, 先行尿道扩张或尿道内切开。12例行经尿道前列腺钬激光剜除术(HoLEP),术后3例出现严重尿道狭窄而接受再次手术, 9例排尿通畅;4例逆向射精;2例暂时性尿失禁。9例行腹腔镜前列腺剜除术, 术后均排尿通畅, 无严重尿道狭窄、暂时性尿失禁和逆向射精。腹腔镜前列腺剜除术治疗合并轻度尿道狭窄的BPH较HoLEP能降低尿道狭窄的风险。     

应用钬激光前列腺剜除术治疗1000余例良性前列腺增生症的经验

在良性前列腺增生症治疗效果方面,钬激光前列腺剜除术(HoLEP)是目前唯一优于TURP的内镜技术,其不受前列腺体积的限制。作者报道了应用HoLEP治疗1 000余例良性前列腺增生症患者的经验。1998年6月至2009年3月,作者所在医院共施行钬激光前列腺剜     

经尿道钬激光前列腺剜除术

近年来钬激光前列腺剜除术(HoLEP)得到快速发展,被认为最有可能取代前列腺电切术(TURP)成为手术治疗前列腺增生(BPH)的新"金标准"。本文回顾了近年来国内外相关文献,总结HoLEP的临床疗效,并与TURP及开放前列腺切除术进行系统对比,进一步证明HoLEP治疗BPH的安全性及有效性。     

钬激光前列腺剜除术治疗前列腺增生80例报告

我院自2004年4月--2006年4月，采用钬激光前列腺剜除术（holmium laser enucleation of the prostate，HoLEP）治疗前列腺增生（benign prostatic hyperplasia，BPH）80例，取得了较好疗效，总结如下。     

钬激光前列腺剜除术治疗大体积前列腺增生的疗效及安全性

目的 探讨钬激光前列腺剜除术(HoLEP)治疗大体积(＞80 mL)良性前列腺增生(BPH)的疗效和安全性.方法 收集2017年10月至2018年12月在本院行HoLEP的128例大体积BPH患者的临床资料.记录围手术期指标如剜除时间、粉碎时间、获取前列腺组织标本质量、术后膀胱冲洗时间等.术后1、6、12个月时评估国际...     

Apoptotic regulators in prostatic intraepithelial neoplasia (PIN): value in prostate cancer detection and prevention

Early diagnosis of prostate cancer holds tremendous promise for the effective therapy and impact on survival of prostate cancer patients. High-grade prostatic intraepithelial neoplasia (HGPIN) is generally accepted as a lesion indicative of a late pathological event in the premalignant changes leading to full development of prostate cancer. This review seeks to identify specific molecular events that may be linked directly to the molecular transition from benign prostate epithelial cells to prostate carcinoma. HGPIN is pathologically detected in a limited group of men undergoing prostate cancer screening for an elevated serum prostate-specific antigen (PSA) or abnormal digital rectal examination (DRE). Loss of apoptotic control provides a molecular basis for the contribution of specific defective steps in the pathway towards development and progression of prostate cancer. Comparative dissection of the apoptosis status and expression profile of key apoptotic regulators among foci of highly proliferative benign prostatic epithelium, PIN and prostate adenocarcinoma from adjacent areas of the same gland revealed a novel insight into the dysfunctional apoptosis events contributing to prostate carcinogenesis. The sequential and notable loss of the three critical signaling components of the apoptotic action of transforming growth factor-beta (TGF-beta), in the prostate, that is, the transmembrane receptor II (TbetaRII), the key cell cycle inhibitor p27(Kip1), as well as the protagonist downstream effector of the TGF-beta signaling mechanism, Smad4, points to their potential value to 'faithfully' characterize HGPIN, as a premalignant prostate lesion. Recent evidence on the molecular changes in apoptosis regulators contributing to HGPIN and their role as molecular markers of disease onset, as well as candidates for therapeutic targeting/chemoprevention of prostate cancer in its early stages will be discussed.     

Changes in tumor markers following cryosurgery of prostate carcinoma

Cryosurgery is performed in poor risk cases of prostate carcinoma with dysuria. This modality has been reported to reduce the metastatic lesion postoperatively in cases of prostate carcinoma accompanied by metastasis and is employed as an adjuvant therapy of prostate carcinoma. However, many cases are already at an advanced stage and have undergone other therapeutic modalities and as a result the exact role of cryosurgery in prostate carcinoma is not clear. The present investigation was undertaken to clarify the effectiveness of cryosurgery in prostate carcinoma. The patients consisted of 21 untreated cases of histologically confirmed prostate carcinoma admitted our hospital during the 5-year period from December, 1982 to December, 1987, in all of whom treatment by cryosurgery alone was indicated, i.e., up stage B, and in whom changes in prostate carcinoma tumor markers, alkaline phosphatase (ALP), acid phosphatase (ACP), prostatic ACP detected enzymatically (PACP), and by radioimmunoassay (PAP), gamma-seminoprotein (gamma-Sm), and prostate specific antigen (PSA) were measured. During the same period, changes in tumor makers in 11 cases of prostate hypertrophy treated by transurethral resection of prostate (TUR-P) were also examined. The tumor markers were measured prior to cryosurgery and 1, 3, 7 and 14 days postoperatively as well as at 1, 3 and 6 months. Following TUR-P, in the cases of prostate hypertrophy, no postoperative changes in ALP, ACP or PACP were observed but there was elevation of PAP and gamma-Sm at day 1 and elevation of PSA until day 3, but none of these were statistically significant differences.(ABSTRACT TRUNCATED AT 250 WORDS)     

Prostate specific antigen density correlates with features of prostate cancer aggressiveness

PURPOSE: An increased prostate specific antigen density (serum prostate specific antigen divided by prostate volume) is an established parameter to help determine the need to perform prostate biopsies. A man with a high prostate specific antigen and a normal size prostate gland is more likely to have cancer than a man with the same prostate specific antigen and a large gland. Prostate specific antigen in relation to prostate size should also reflect the volume of cancer in the gland. One group defined clinically unimportant prostate cancer as tumor volume less than 0.5 cc, organ confined disease and Gleason less than 7. Another group noted that at the time of biopsy, a prostate specific antigen density less than 0.15 ng/ml/cc combined with low risk clinical tumor features predicted insignificant cancer. There are limited published validating data on the association of prostate specific antigen density with the criteria for prostate cancer aggressiveness. We tested the association of prostate specific antigen density with features of tumor aggressiveness in a screened and in a nonscreened cohort of patients with clinically localized prostate cancer treated with radical prostatectomy. MATERIALS AND METHODS: The screened patient cohort included 1,280 patients with screen detected prostate cancer treated from 1990 to 2002 at Washington University, and the nonscreened cohort included 382 patients treated from 2003 to 2004 at Northwestern University. We recorded the clinical and pathological tumor parameters in a prospective database. Parameters evaluated were pathological tumor stage, Gleason sum, tumor volume, biochemical progression and the previously mentioned 2 criteria for clinically unimportant cancers. We grouped patients into 4 prostate specific antigen density categories of less than 0.1, 0.1 to 0.14, 0.15 to 0.19 and greater than 0.19 ng/ml/cc. RESULTS: There was a significant trend for worsening clinicopathological prognostic features as prostate specific antigen density increased. There were 357 (82%), 283 (75%), 171 (75%) and 192 (55%) men with organ confined disease with clear surgical margins if prostate specific antigen density was less than 0.1, 0.1 to 0.14, 0.15 to 0.19 and greater than 0.19 ng/ml/cc, respectively (p <0.001). There were 86 (20%), 102 (27%), 64 (28%) and 157 (45%) men with a Gleason sum greater than 7 when grouped into each increasing PSA density category, respectively (p <0.001). There were 91 (21%), 91 (25%), 74 (33%) and 157 (46%) men with a total cancer volume greater than 0.5 cc when grouped into each increasing PSA density category, respectively (p <0.001). Prostate specific antigen velocity was greater than 2 ng/ml per year in 11%, 30%, 27% and 46% of men if prostate specific antigen density was less than 0.1, 0.1 to 0.14, 0.15 to 0.19 and greater than 0.19 ng/ml/cc, respectively (p <0.001). CONCLUSIONS: Prostate specific antigen density measurements are useful in helping to determine the aggressiveness of clinically localized prostate cancer, and can be used as an adjunct in predicting insignificant cancer and outcomes after local therapy.     

A population study of neutering status as a risk factor for canine prostate cancer

BACKGROUND: Prostate cancer has been reported to occur more commonly in neutered than intact male dogs in several case series. This study was undertaken to evaluate risk of prostate cancer in a large population database. The hypothesis was that castration is a risk factor for prostate cancer in male companion dogs. METHODS: Data were derived from recorded visits to North American veterinary teaching hospitals. The Veterinary Medical Databases (VMDB) were queried to yield male dogs with urinary bladder transitional cell carcinoma (TCC), prostate adenocarcinoma (ACA), prostate TCC, prostate carcinoma (CA), and prostate tumors. A second query yielded all male dogs over the age of 4 years without a diagnosis of urinary tract cancer. These populations were compared to determine relative risks for developing each disease, singly and collectively, associated with neutering status. Odds ratios were calculated for breed as a risk factor. RESULTS: Neutered males had a significantly increased risk for each form of cancer. Neutered males had an odds ratio of 3.56 (3.02-4.21) for urinary bladder TCC, 8.00 (5.60-11.42) for prostate TCC, 2.12 (1.80-2.49) for prostate adenocarcinoma, 3.86 (3.13-4.16) for prostate carcinoma, and 2.84 (2.57-3.14) for all prostate cancers. Relative risks were highly similar when cases were limited to those with a histologically confirmed diagnosis. CONCLUSIONS: Breed predisposition suggests that genetic factors play a role in the development of prostate cancer. The risk associated with being neutered is highest for TCC, supporting previous work identifying the urothelium and ductular rather than acinar epithelium as the source of these tumors.     

Prostate-specific antigen in prostatic pathology

Prostate-specific antigen (PSA), like prostate acid phosphatase (PAP), are prostate tissue markers that are useful in prostate disorders. Increased PSA levels are often seen in carcinomas of the prostate, but have also been reported in benign inflammatory disorders of the prostate. We therefore studied PSA levels in 600 patients aged 22 to 89 years to evaluate the usefulness of this marker in prostate disorders. The 600 patients were divided into four groups: 120 normal subjects, 180 patients with carcinoma of organs other than the prostate, 75 patients with carcinoma of the prostate, and 225 patients with benign hypertrophy of the prostate. Results: a significant difference in PSA levels was found between carcinomas and adenomas of the prostate, as well as between stage A carcinomas and adenomas of the prostate. Conversely, non significant difference was evidenced between stage A carcinomas and benign prostatic hypertrophy with inflammation. Rather than a specific marker for cancer, PSA indicates the presence of active prostatic disease, other investigations being necessary to determine whether this disease is malignant. PSA remains extremely useful for monitoring prostate carcinoma patients, especially following radical prostatectomy.     

凋亡抑制基因XIAP在前列腺癌细胞中的表达及与临床病理特征的关系

目的 :研究XIAP基因在前列腺癌细胞系和前列腺癌组织的表达情况 ,及其与前列腺癌临床病理特征的关系。　方法 :应用RT PCR检测前列腺癌组织、正常前列腺组织和前列腺癌细胞株PC 3,DU 14 5 ,LNCaP细胞XIAP基因的表达 ,并通过免疫组化SP法检测 5 6例前列腺癌组织标本XIAP蛋白的表达情况。　结果 :XIAP基因在前列腺癌组织和前列腺癌细胞株PC 3,DU 14 5 ,LNCaP细胞高表达 ,正常前列腺组织无表达。在前列腺癌组织和癌旁组织中 ,XIAP蛋白阳性检出率分别为 5 3.6 % (30 / 5 6 )和 2 1.5 % (12 / 5 6 ) (P <0 .0 1) ;不同分期、分级组XIAP阳性检出率相比差异无显著性 (P >0 .0 5 )。　结论 :凋亡抑制基因XIAP与前列腺癌相关 ,在前列腺癌发生过程中具有重要的作用 ,有可能成为前列腺癌治疗的靶标。     

Natural history of human prostate gland: Morphometric and histopathological analysis of Japanese men

BACKGROUND: To clarify the pathology of the development of prostatic disorders such as inflammation, cancer, and hyperplasia, we compared histopathological findings of the prostate according to age group. METHODS: Whole-mount sections of prostates were used to assess the relationship between age and prostate weight (n=962), prostate histological composition in the transition zone (TZ) and in the peripheral zone (PZ) (n=68), prostate histopathological findings by zone (n=102), and comparison of latent tumor development by age group (n=1,815). RESULTS: A rapid increase in prostate weight from birth to the 20s was followed by a slow rise thereafter. Volume increases (P<0.01) were observed in all components of glandular epithelium, glandular lumen, and stroma in the TZ from the 40s to 70s inclusive. In the PZ, the epithelial and stromal volumes tended to decrease in an age-dependent manner (P<0.05). Calculi and lymphocyte infiltration were detected at a relatively early age, with a tendency towards an age-dependent increase. Glandular dilation and nodular hyperplasia were noted first in the 30s group, also with a tendency towards age-dependent increase. Latent tumors were first detected in the 30s group (5.6%), and slowly increased thereafter. CONCLUSIONS: There was an age-dependent trend towards prostate glandular dilation and prostate enlargement with inflammation. It was demonstrated that tumor and hyperplasia have a long natural history, usually starting in the fourth decade of life, accompanied by dynamic changes with age in glandular tissue composition as well as cell proliferation activity.