Objective To resolve the tough problem of how to observe the growing cells in an opaque vector. Methods The urethral epithelial cells from a young male New Zealand rabbit were inoculated, and were primarily cultured in vitro and subcultured for 3 passages. Then, the urethralepithelial cells were cultured in the collagen chitosan complex for 3, 7, 14 and 21 days. The cells were dyed with 6-carboxyfluorescein diacetateacetoxymethyl ester and propidium iodine, respectively. Then, Interactive Laser Cytometer was used to detect the growing cells. Results The urethral epithelial cells grew and proliferated very well in the collagen chitosan complex vector. After the urethral epithelial cells grew in the collagen-chitosan complex vector for 3 and 7 days, the fluorescent density amount of the surviving cells were(1.09±0.13)×10.8 and (2.04±0.13)×10.8, respectively. However, after 14and 21 days, the fluorescent density amount of the surviving cells was (0.55± 0.09)×10.8 and (0.47±0.03)×108, respectively. There was a significant difference when compared with the amount of the surviving cells at 3 and 7 days（P＜0.05）.Conclusion Using Interactive Laser Cytometer for measurement of the green and red fluorescent densities of different waves, the activity of the cultured urethral epithelial cells in vitro can be rapidlymeasured with the in situ quantitation method. This method solves a difficult problem of observing the growing cells in an opaque vector. The dynamic growing state of the engineering tissues can be observed.
目的:探讨基层医院前列腺增生并膀胱结石的微创治疗方法。方法:联合经尿道等离子双极电切与耻骨上小切口治41例前列腺增生症并膀胱结石。结果:手术时间40~110min, 平均55min,术后3d拔造瘘管, 第5~6天拔除尿管,排尿通畅, 无电切综合征(TURS)、大出血等并发症,住院时间7±1.5天。数字疼痛评分0~6,平均3.5。结论：等离子体双极电切结合耻骨上小切口是治疗前列腺增生并膀胱结石的一种快速、安全有效、微创的手术方法,值得在基层医院推广。
Objective To evaluate the effect of pretreatment with epristeride on decreasing intraoperative bleeding during transurethral resection of prostate (TURP) and to study its mechanism. Methods A total of 60 patients with benign prostatic hyperplasia undergoing TURP were divided into two groups: 30 patients were pretreated with epristeride 5 mg×2 daily for 7 to 11 days before TURP, and 30 patients did not receive any pretreatment. The operations for the two groups of patients were conducted by the same doctors. The operation time, the weight of resected prostatic tissue, and the volume of irrigating fluid were recorded. Blood loss, bleeding index, and bleeding intensity were calculated. Microvessel density (MVD), vascular endothelial growth factors (VEGF), and nitric oxide synthase type III (eNOS) expression were measured by the immunohistochemistry SPmethod in prostatic tissue. Results In the epristeride and control groups, the mean blood loss was 179.51±78.29 ml and 237.95±124.38 ml (Plt;0.05); the mean bleeding index was 7.68±3.94 ml/g and 9.73±3.42 ml/g (Plt;0.05); the mean bleeding intensity was 2.43±1.03 ml/min and 3.30±1.50 ml/min (Plt;0.05); the mean value of MVD was 18.80±5.68 and 23.70±4.91 (Plt;0.05); the mean rank of VEGF was 23.48 and 31.77 (Plt;0.05); and the mean rank of eNOS was 22.36 and 31.14 (Plt;0.05), respectively. Conclusion Pretreatment with epristeride decreases intraoperative bleeding during TURP. The preliminary results suggest that angiogenesis in the prostatic tissue is suppressed.
Objective To assess the efficacy of finasteride in treating perioperative bleeding in patients undergoing transurethral resection of the prostate (TURP). Methods We searched MEDLINE (1966 to 2005), EMBase (1984 to 2004), CBM (1980 to 2005), The Cochrane Library (Issue 4, 2005) and relevant journals to identify cl inical trials involving finasteride in patients undergoing TURP. We also checked the references in the reports of each included trial. The qual ity of randomized controlled trials (RCTs) was assessed according to the methods recommended by The Cochrane Collaboration, and the qual ity of non-RCTs was assessed based on the methods recommended by Jiang-ping Liu, Stroup and Hailey. Two reviewers extracted data independently and data analyses were conducted with The Cochrane Collaboration’ s RevMan 4.2. Result We included 4 RCTs and 1 non-RCT. The qual ity of 3 RCTs was graded C and the other one was graded B. The quality of the non-RCT was relatively high. Meta-analyses showed that with comparable age, international prostate symptom score, prostate specific antigen, preoperative volume of prostate and excision volume between the two groups (Pgt;0.05), the perioperative bleeding volume (WMD –85.44, 95%CI –117.31 to –53.58), the bleeding volume per gram of resected prostate tissue (WMD –3.5, 95%CI –6.34 to –0.58) and hemoglobin reduction (WMD –1.61, 95%CI –1.96 to –1.26) of the finasteride group were significantly smaller than those of the control group. Conclusion The evidence currently available indicates that preoperative use of finasteride may reduce bleeding in patients undergoing TURP.
Objective To explore the possibility of small intestinal submucosa (SIS) for reconstruction of urethral defect. 〖WTHZ〗Methods Twenty-four male rabbits weredivided into 4 groups: group A (the tubulate SIS graft for urethral repair), group B (control group, urethral tubulate defect), group C (the SIS patch graft forurethral repairs), group D (control group, urethral part defect). Then the regenerative segment was studied with histological technique by hematoxylineosin straining and immunohistological straining for α-actin after 6 and 12 weeks postoperatively. The retrograde urethrography and urodynamics were used to evaluate the function of the regenerative urethra at 12 weeks after operation. Results In groups A and C, at 6 weeks after operation, the luminal surface of matrix was completely covered by urothelium, minimal SIS graft was observed in the extracellular matrix, new smooth-muscle cells was confirmed; however, more inflammatory cells were observed in the host-matrix anastomosis in group A than in group C. At 12 weeks postoperatively, the regenerative tissue was equivalent to the normal urethral tissue and SIS disappeared in group C, but some minimal SIS grafts were observed in group A. In groups B and D, urethral strictures and fibrous connective tissue were observed except ３ cases. The urethrography showed wide smooth urethral in group A and C, meawhile urodynamic evaluation didn’t demonstrat significant difference(P＞0.05) in the bladder volume and the maximum urethral pressure between preoperation and postoperation in group A or group C. Conclusion SIS can be a useful material for urethral repair in rabbits, the SIS patch graft is superior to the tubulate SIS graft in urethra reconstruction.
Objective To review the surgical management for Chinese children urethral injury (CUI). Methods According to the evidence-based medicine principal and the approach of systematic review, we searched Chinese Biomedicine Database and PubMed, all literature retrievals were updated until September 8th, 2008. At least two reviewers independently screened the studies for eligibility, evaluated the quality with the Joanna Briggs Institute critical appraisal checklist for descriptive/cases series studies and extracted the data with excel 2003 from the eligible literatures, with confirmation of cross-check. Different views were consulted by the third party. The characteristics of literature, research quality, study content, cases characteristics, diagnosis and treatment, outcome appraisal and follow-up were analyzed. Results A total of 22 studies involving 1019 patients were included, most patients were male children. All 22 studies were descriptive researches and the study quality was low. The etiologies were mainly pelvic fracture and straddle injury as results of misadventure. The diagnosis was based on the relatively objective diagnostic tests such as urethrography, operations research and the exploration of urethral bougie etc in 16 studies. The most categories of CUI were obsolete urethral injuries such as stricture and atresia, the injury sites mainly lied in posterior urethra. The management of CUI were divided into the primary treatment included the first-stage operation and delayed-stage repair, and the second-stage management. Moreover, the individual operation was according to the injury sites and patterns. A total of 14 studies reported the outcomes of operation at various success rates (52%-100%). Except 4 studies, the others reported incomplete follow-up time, from 3 months to 16 years, but few adopted objective methods such as urethrography and urodynamic test. The main complications were urethral stricture, urinary fistula and sexual dysfunction etc. Conclusion The quality of CUI studies was low for lack of prospective randomized controlled trials. The major patients were male children with posterior urethra injuries. Because of the heterogeneitiy of the individual case, different surgeon’s managements and the variety of treatment options, we cannot make identical conclusion. We need more researches with high methodological quality. Moreover, we recommend that, following the clinical practice guideline of CUI made by Chinese Urological Association for the Chinese urologist, and then performing individual surgical management.
Objective To provide the anatomic basis for the posterior urethral repair via the perineal approach. Methods The anatomicconstructions andtheir relationships of the perineal approach from skin to the membranous and prostate apical urethra were observed and some related data were measured in 12 adult male specimens by microanatomy, and the procedures of urethral repair via the perineal approach were carried out in 3 fresh male specimens. Results All the blood vessels and nerves, which supplied the scrotum, the perineum, and bulbourethra, passed lateral-medially. The cavernous nerves coursed posterolaterally from the bottom to the apex of the prostate, pierced the urogenital diaphragm and passed laterally to themembranous urethra in a status of gridding, whose width was (12.11±2.32) mm.Conclusion The structures of the perineum and around the posterior urethra are complicated. The strategy for diminishing the damages to them is that all structures must be dissected strictly in the midline. Confining the dissections strictly to the range of 5 mm from the membranous urethra and resecting the apical prostatic tissues anterolaterally could avoid impairments of the cavernous nerves.
Objective To document the effect of surgical steps, including penile degloving, plate transection, dorsal plication, and fasciocutaneous coverage, in primary hypospadias repair on penile length. Methods A consecutive series of 209 prepubertal boys with primary hypospadias repair was included with the age ranged from 10 to 97 months (mean, 31.7 months). Intraoperative stretched penile length (SPL) was measured before operation (n=209), and after each step, namely penile degloving (n=152), plate transection (n=139), dorsal plication (n=170), and fasciocutaneous coverage (n=209). SPLs before and after each steps or the entire operation were analyzed. The SPL was compared between plate transection group and plate preservation group, dorsal plication group and non-plication group, and plate preservation with plication group and plate preservation without plication group, respectively. Differences of SPL between before and after each steps were analyzed with factors including neourethra length, rest dorsal penile length, rest ventral penile length, preoperative SPL, and the degree of penile curvature after penile degloving, with multivariate linear regression analysis. ResultsAll the four steps resulted in SPL difference. The SPL increased after penile degloving and plate transection (P<0.05), and decreased after dorsal plication and fasciocutaneous coverage (P<0.05). The SPL increased after all steps were completed (P<0.05). In patients with plate transection, postoperative SPL increased when compared with that before operation (P<0.05). No significant difference was noted in patients without plate transection (P>0.05). And there was significant difference in the increased length of SPL between patients with and without plate transection (P<0.05). In patients with dorsal plication, a significant increase of postoperative SPL (P<0.05) was noted. No significant difference was noted in patients without dorsal plication (P>0.05). And there was no significant difference in increased length between patients with and without dorsal plication (P>0.05). When patients with plate transection were excluded, dorsal plication resulted in no significant difference on postoperative SPL (P>0.05). The increased length of SPL after penile degloving, dorsal plication, or cutanofascial coverage was not related to the neourethra length, the rest dorsal penile length, the rest ventral penile length, the preoperative SPL, and the degree of penile curvature (P>0.05). However, the neourethra length and preoperative SPL were the influencing factors for the increased length of SPL after plate transection (P<0.05). ConclusionThe main steps in primary hypospadias repair can change SPL. The lengthening effect of plate transection would not be counteracted by dorsal plication. Dorsal plication makes no significant difference on postoperative SPL.