Transrectal elastographic monitoring of the transurethral balloon pressure in urethral dilation for catheter-dependent patients with benign prostatic hyperplasia

Background

Foley’s catheter indwelling gives temporary relief for lower urinary tract obstruction, especially in case of severely symptomatizing benign prostatic hyperplasia (BPH). Several complications of long-term or frequent catheter indwelling have been reported in catheter dependent patients, specifically to those who are unfit for operative intervention.

Objectives

Our aim was to find a safe, non-invasive relief from symptom severity, as well as, incapacitating complications of Foley’s catheter in catheter-dependent patients.

Methods

A total of 107 catheter-dependent men, or who had frequent Foley’s catheter indwelling in case of BPH, participated in the present study. Preliminary estimation of the post-micturition residual urine was obtained. Ultrasound elastography was used to assess the transurethral balloon pressure of the double balloon silicon-coated catheter, adjudicated by ureteromat, and maintained in situ for 6 days in all patients. Basic follow up once-a-month has been performed up to 6 months.

Results

Effectual urethral patency was noted in 89.7% patients at the end of the third month. The procedure was repeated for 11 patients shortly after 3 months, for 7 patients after 4 months and for 28 patients after 5 months, with no reported prostatic urethral injury. No stricture recurrence was noted in 61 patients up to 6 months.

Conclusions

Preliminary results indicate that prostatic urethral balloon dilation in BPH catheter-dependent patients is inexpensive, safe, and would be a potentially effective option in maintaining the prostatic urethral patency. Elastographic justification of the transurethral balloon has proved to be helpful.     

绿激光PVP手术与TURP手术治疗前列腺增生症的对照研究

 目的 评价经尿道前列腺绿激光汽化术(PVP)治疗前列腺增生症的近期疗效.方法 122例<60 g前列腺增生症患者进行非随机的双中心研究,其中PVP手术组71例,TURP手术组51例,比较两组的手术时间、出血量、近期疗效及并发症.结果 两组术后前列腺国际症状评分(IPSS)、生活质量评分(QOL)、最大尿流率和残余尿量均较术前明显改善(P<0.05),PVP组平均术中出血量、留置尿管时间及近期并发症明显小于TURP组(P＜0.01).结论 绿激光PVP手术与TURP手术治疗<60 g前列腺增生症近期疗效相似,且绿激光PVP手术具有出血少、尿管留置时间短、并发症少的特点.     

经尿道前列腺低容量切除治疗高危前列腺增生临床分析

目的探讨高危前列腺增生患者行经尿道前列腺低容量切除的效果及可行性。方法对42例合并有心脑血管病及糖尿病等其他基础疾病的老年患者行经尿道前列腺低容量电切术（TURP）,观察术后疗效。结果术后最大尿流率（MFR）、国际前列腺症状评分（IPSS）等均有改善,原基础疾病未加重。结论术前做好充分准备,术中快速准确操作,是提高疗效、降低手术风险及术后并发症的关键。     

Benign prostatic hypertrophy: retrograde transurethral dilation of the prostatic urethra in humans. Work in progress

Retrograde transurethral balloon dilation of the prostatic urethra was performed in five human volunteers with benign prostatic hypertrophy. Each patient underwent cystoscopy, uroflow studies, voiding cystourethrography, retrograde urethrography, and magnetic resonance imaging before dilation and at defined intervals afterward. The longest follow-up to date is 8 months. Patients were given topical anesthetics and mild sedatives, and dilation was performed with a 25-mm urethroplasty balloon catheter inflated at 3-6 atm for 10 minutes. All catheter manipulations were done with a guide wire and under fluoroscopic control. Significant resolution of symptoms of prostatism was seen in four patients. The unsatisfactory results in the last patient were believed to be caused by ineffectual dilation of predominantly middle lobe hypertrophy--a condition that is now regarded as a contraindication to dilation. This technique has promise to replace transurethral resection of the prostate as the treatment of choice for this common male ailment.     

Esophageal anastomotic leaks: preliminary results of treatment with balloon dilation

Disruption of a cervical esophagogastric or esophagocolonic anastomosis shortly after surgery is a common complication, and fistula drainage from the leaking anastomosis may be prolonged. Narrowing of the anastomosis apparently contributes to the development and maintenance of the fistula. Fluoroscopically guided balloon dilation of anastomotic strictures was performed in three patients with anastomotic leaks. Preliminary results suggest that the procedure is safe and promotes healing of the fistula.     

食管良性狭窄球囊导管扩张术后再狭窄病理机制的实验研究

目的　探讨食管良性狭窄球囊导管扩张术后食管再狭窄的发生机制。方法　采用双球囊导管法制作大鼠食管良性狭窄模型 (对照组 ) ;使用PTCA球囊导管对食管良性狭窄进行扩张制作食管再狭窄模型 (实验组 )。大鼠食管狭窄和再狭窄形成过程中的定量指标采用图像分析仪测量、定性指标采用免疫组织化学方法观察。结果　成功制作大鼠食管良性狭窄和再狭窄模型 49个。实验组术后食管黏膜层、肌层及全层的载面积和周长都有明显增加 ,与对照组比较统计学上有意义 (P <0 .0 5 )。实验组术后第 5天 ,增殖细胞核抗原 (PCNA)开始表达 ,持续到 1个月仍有表达。术后第 1天 ,纤维连接蛋白(FN)就开始表达 ;第 2 1天 ,FN表达仍呈阳性 ;第 30天时 ,FN仍有部分呈强阳性表达。结论　食管良性狭窄球囊导管扩张术后再狭窄的主要原因之一是PCNA和FN持续的过度分泌     

经尿道气化电切治疗重度前列腺增生症

目的探讨重度前列腺增生症(BPH)的治疗方法。 方法应用经尿道前列腺电气化术(TUVP)加经尿道前列腺电切术(TURP)联合治疗重度BPH患者60例。 结果 手术时间50-90 min,平均75 min,平均切除前列腺组织70 g。仅发生1例先兆电切综合症。术后平均6天拔管,自行排尿通畅。IPSS由术前平均25.5分下降至术后平均7.0分(P<0.001),最大尿流率(Qmax)由术前平均5.2 ml/s升至术后平均18.9 ml/s(P<0.001),剩余尿量由术前平均100 ml降至术后平均15 ml。术后继发性出血1例,一过性尿失禁1例。 结论TUVP加TURP联合治疗BPH兼有两者优点,是彻底治疗重度BPH安全、有效的方法。     

Liquid (188)Re-filled balloon dilation for the treatment of refractory benign airway strictures: preliminary experience

PURPOSE: To present the preliminary results of beta irradiation with use of liquid rhenium 188 ((188)Re)-filled balloon dilation in the treatment of refractory benign airway strictures. MATERIALS AND METHODS: Ten sessions of beta irradiation by using liquid (188)Re-filled balloon dilation were prospectively performed in nine patients with refractory bronchial strictures between 2003 and 2006. Indications for treatment were dyspnea caused by repeat stricture or no response to previous treatment (ie, balloon dilation and/or temporary stent placement or laser therapy) in seven patients and dyspnea caused by exuberant granulation tissue formation at the distal end of the placed stent in two. To assess the treatment efficacy, the authors calculated and compared the mean intervals of interventional treatments before and after dilation with (188)Re and mercaptoacetyltriglycine (MAG(3))-filled balloons. RESULTS: Liquid (188)Re-filled balloon dilation was successfully performed in all nine patients, with no procedure-related complications. Immediately after the procedure, all patients showed resolution of their dyspnea. Five patients remained asymptomatic at 5-25-month follow-up. Four patients experienced dyspnea caused by recurrent stricture 1-10 months after dilation. The mean intervals between interventional treatments increased significantly from 3.1 months +/- 2.1 before (188)Re-MAG(3)-filled balloon dilation to 10.8 months +/- 8.8 after (188)Re-MAG(3)-filled balloon dilation in all nine patients (Wilcoxon signed rank test, P = .025). CONCLUSIONS: beta irradiation with liquid (188)Re-filled balloon dilation can be safely used for refractory benign airway strictures. A large study with longer follow-up is needed to draw a definite conclusion.     

经尿道前列腺汽化电切术联合疝无张力修补术治疗良性前列腺增生症并腹股沟疝疗效分析

目的 探讨良性前列腺增生症（BPH）合并腹股沟疝的一期手术方法。方法2004年10月-2008年1月,行经尿道前列腺汽化电切术（TUVP）治疗BPH,同时采用聚丙烯网片（PPM）无张力修补腹股沟疝,一期手术治疗BPH合并腹股沟疝患者56例。结果手术效果良好,具有创伤小、恢复快、疼痛轻等优点。术后国际前列腺症状评分（IPSS）为0～7分,生活质量明显改善。平均术后住院时间为5．4天。随访6个月～4年,无严重术后并发症及复发。结论同期行TUVP及腹股沟疝修补术,方法简单、疗效肯定,可一次性完成手术,使患者免受二次手术痛苦。     

经尿道三种电切术治疗前列腺增生的疗效比较

目的：比较经尿道电切（TURP）、经尿道汽化电切（TUVP）、经尿道等离子电切（PKRP）3种手术方法治疗良性前列腺增生的疗效及并发症。方法：分别采用TURP、TUVP、PKRP3种方式治疗BPH患者615例。TURP组270例,TUVP组280例,PKRP组65例,3组病例术前前列腺症状评分（IPSS）、剩余尿量（RUV）、最大尿流率（Qmax）、生活质量评分（QOL）比较差异均无统计学意义（P〉0．05）。比较3组手术时间、术中出血量、术后尿管留置时间、住院天数、术后并发症发生率及疗效。结果：TuRP组成功267例（99％）;TUVP组成功274例（98％）;PKRP组65例均获成功。TURP、TUVP、PKRP组手术时间组问比较差异无统计学意义（P〉0．05）;3组术中出血量组间比较差异有统计学意义（P〈0．01）;3组术后平均留置尿管时间分别为4．1、4．2、3．5d（P〉0．05）;3组平均住院时间分别为6．2、6．7、5．1d（P〈0．01）。TURP组并发症发生率2．6％。TUVP组并发症发生率6．8％。PKRP组术后并发症发生率3．1％。术后3、6个月随访,3组IPSS、RUV、QOL均较术前明显下降,Qmax均较术前明显增加,但组间比较差异均无统计学意义（P〉0．05）。结论：3种方法均有明确的临床效果,临床上可根据患者情况和适应证选择不同方法,以获得更好的临床疗效。     

良性前列腺增生、前列腺癌的CT多期强化特征与血管生成关系的研究

目的:探讨MVD、微血管相关指标及bFGF在BPH和PCa中的表达情况、与临床病理特征的关系及其相互之间的关系,以及和MSCT多期扫描强化特征的相关性。方法:对经病理证实的35例BPH和27例PCa患者术前均行MSCT扫描,绘制BPH和PCa时间-密度曲线(T-DC),并计算曲线升段的斜率(S);所有标本行CD34、bFGF的免疫组化染色。结果:时间-密度曲线分三种类型,在两组病例分布的差异有统计学意义(P<0.01)。BPH和PCa组织中MVD分别为11.00±4.14和32.11±13.19,BPH微血管平均直径等指标比PCa的相应指标要大(P<0.01)。bFGF在PCa中的表达高于在BPH中的表达(P<0.01)。斜率(S)与MVD、bFGF及MVD与bFGF有相关性(P<0.05);在前列腺癌中,斜率(S)与PCa的Gleason分级、肿瘤分化程度有相关性(P<0.05)。MVD与Gleason分级、肿瘤分化程度分级之间有相关性(P<0.01)。结论:bFGF及MVD在PCa中的表达水平高于在BPH中的表达。MSCT多期扫描强化特征能够显示BPH、PCa的血供情况,在一定程度上反映增生及癌组织中血管生成因子的表达及微血管的生成。     

前列腺栓塞术治疗良性前列腺增生的临床应用进展

常规的药物与手术治疗对于良性前列腺增生均有其局限性。前列腺动脉栓塞术是近年来新兴的缓解前列腺增生引起的下尿路症状的新技术。作者综合分析国内外前列腺栓塞术的相关文献及专家观点,并提出想法,为良性前列腺增生的治疗提供其他可供选择的安全、有效治疗途径。     

选择性绿激光汽化术治疗良性前列腺增生症的疗效和并发症

目的:探讨选择性绿激光前列腺汽化术(PVP)治疗良性前列腺增生(BPH)的疗效和并发症。方法:应用PVP治疗BPH患者204例。结果:术后最大尿流率增加,IPSS评分、QOL评分、残余尿量均较术前下降,差异均有统计学意义(P<0.05)。术后出现的并发症有膀胱痉挛、尿路刺激症状、排尿困难、继发性出血、尿失禁、发热等,经治疗好转。结论:此方法操作简单、出血少、痛苦较小,适于高龄、高危患者。但仍有一定并发症,要妥善处理。     

Prostatic urethroplasty with balloon catheter as a nonsurgical alternative for benign prostatic hyperplasia.

Prostatic urethroplasty with a balloon catheter is an easy procedure to perform, but certain guidelines must be followed to avoid complications. This procedure will reduce the overall treatment cost of benign prostatic hyperplasia significantly. Preliminary results range from 70% to 85% symptomatic improvement or resolution of the prostatism symptoms. Its recurrence rate is still not known, but a small one is expected. Nevertheless, because of the noninvasiveness, low cost, and simplicity of the procedure, it potentially could be repeated, if necessary. This procedure is one that when it is done in combination with another specialist, in this case a urologist, the patient will benefit by the use of the expertise of both the urologist's knowledge of the disease of the urinary system and the interventional radiologist's skills with catheters and guide wires.     

MR imaging-guided cryoablation for the treatment of benign prostatic hyperplasia

A patient with benign prostatic hyperplasia presented with chronic lower urinary tract symptoms despite prior surgery and continued medical therapy. Using a magnetic resonance imaging–guided transperineal approach, two cryoprobes were placed into the transition zone of the prostate gland, and two cryoablation freeze-thaw cycles were performed. At 10 weeks after treatment, the frequency of nocturia had decreased from once every 1.5 hours to once per night, urinary peak flow rates had increased from 5.1 mL/s to 10.3 mL/s, and postvoid residual urinary bladder volume had decreased from 187 mL to 58 mL. Improved flow rates and symptoms remained stable 16 weeks after treatment.     

坦索罗辛联合托特罗定治疗良性前列腺增生伴膀胱过度活动症的临床研究

目的探讨坦索罗辛联合托特罗定用于治疗前列腺增生合并膀胱过度活动症患者的临床效果和安全性。方法将我院2012年7月—2014年1月共82例前列腺增生合并膀胱过度活动症患者随机分为观察组(联用坦索罗辛和托特罗定)和对照组(仅用坦索罗辛),每组41例,治疗8周。比较两组国际前列腺症状评分(IPSS)、过度活动症评分(OABSS)、生活质量评分(QOLS)、最大尿流率(Qmax)、残余尿量(PVR)、日间排尿次数、尿急次数、急迫性尿失禁次数、夜尿次数的差异。结果两组患者治疗后IPSS、OABSS、QOLS、Qmax、PVR、日间排尿次数、尿急次数、急迫性尿失禁次数、夜尿次数等指标均较治疗前改善,差异有统计学意义(P<0.05)。观察组除PVR外其他各观察指标在治疗前后的差值与对照组比较,差异均有统计学意义(P<0.05)。观察组和对照组不良事件发生率分别为7.3%和4.9%(P>0.05),两组均无严重不良事件发生。结论坦索罗辛联合托特罗定治疗前列腺增生合并膀胱过度活动症患者安全有效,其效果优于单用坦索罗辛。     

31P NMR of phospholipid metabolites in prostate cancer and benign prostatic hyperplasia

¹H MRSI in vivo is increasingly being used to diagnose prostate cancer noninvasively by measurement of the resonance from choline‐containing phospholipid metabolites. Although ³¹P NMR in vivo or in vitro is potentially an excellent method for probing the phospholipid metabolites prominent in prostate cancer, it has been little used recently. Here, we report an in vitro ³¹P NMR comparison of prostate cancer and benign prostatic hyperplasia, focusing on the levels of the major phospholipid metabolites. Unlike phosphocholine and glycerophosphocholine, phosphoethanolamine and glycerophosphoethanolamine (and their ratio) were significantly different between cancer and benign prostatic hyperplasia. The high level of phosphoethanolamine+glycerophosphoethanolamine relative to phosphocholine+glycerophosphocholine suggests that the former may be significant contributors to the “total choline” resonance observed by ¹H MRSI in vivo. Magn Reson Med, 2010. © 2010 Wiley‐Liss, Inc.     

癃闭康对实验性前列腺增生大鼠前列腺组织增殖细胞核抗原表达的影响

 目的 观察实验性大鼠前列腺组织增殖细胞核抗原(P CNA)的表达及癃闭康对其影响.方法 雄性SD大鼠随机分为对照组、模型组、前列康组、癃闭康低、中、高不同剂量组.去势加丙酸睾丸酮注射法复制前列腺增生模型,进行不同干预后观察前列腺湿重、前列腺指数、PCNA的表达及病理变化.结果 模型组大鼠前列腺湿重、前列腺指数及组织PCNA阳性表达高于对照组(P<0.01);癃闭康治疗组、前列康组各项指标低于模型组(P<0.01);癃闭康高剂量组各项指标低于癃闭康中、低剂量组(P<0.01)及前列康组(P<0.01),光镜下病理结构接近对照组.结论 前列腺增生可能与PCNA表达增高有关,癃闭康可通过调节PCNA表达抑制前列腺增生,且高剂量组效果显著.