The Application Of PKRP In Patients With BPH

Part I Histopathological investigation comparing the domestic and imported bipolar transurethral resection (BPR) device’s effects on prostateObjective To compare the domestic and imported bipolar transurethral resection (BPR) device in terms of the effects on prostatic histopathology.Materials and Methods 18 adult dogs were randomly assigned to 2 groups, with one group (9 animals) receiving BTR surgery using the domestic device and the other the imported device. Animals were executed immediately after the surgery, and 1 week and 6 weeks post-operation. Prostate samples were obtained from executed animals, which were examined microscopically for histopathological changes and thickness of the coagulation zone of the wound bed.Results For samples collected immediately after the surgery and 1 week post-operation, the thickness of the coagulation zone were (235.45±25.37) μm and (110.87±20.23) μ m in the domestic device group, and (238.12±32.47) u m and (112.64±18.76) μm in the imported device group, without statistical significance (P>0.05).6 weeks after the surgery, the coagulation zone was completely detached from the wound bed in both groups, replaced by regenerated urothelial epithelium. Inflammatory reaction was noted in samples from both groups collected at each time point, with damaged epithelium and dilated gland lumen under the coagulation zone as the main manifestation.Conclusion Domestic and imported BTR device has similar effects on dog prostate in terms of histopathology.Part Ⅱ The application of PKRP in patients with BPH(>80g)Objective To study the application and the clinical efficacy of transurethral plasma kinetic resection of prostate (PKRP) in patients with benign prostatic hyperplasia (prostate volume greater than 80g) and compare the effect of PKRP to patients with prostate volume.Methods clinical data of patients with benign prostatic hyperplasia (prostate volume greater than 80g) treated with PKRP from 2011 January to December in urology department of zhongnan hospital was collected and retrospectively analyzed. The clinical information of patients contained preoperative factors (age, prostate size, Qmax, residual urine volume, IPSS, fPSA, tPSA, Hemoglobin, Na+) and post-operative indicators (duration of hospital stay (day), operation time (min), catheter removal (h), re-operation, blood transfusion). Meanwhile, these according to prostate volume are divided into two groups of 80-100g and more than 100g. By the above two groups of age, prostate size, Qmax, residual urine volume, IPSS, fPSA, tPSA, Hemoglobin, Na+, duration of hospital stay (day), resection weight(g), operation time (min), catheter removal (h) were statistically analyzed by t-test, re-operation and blood transfusion were analyzed by chi-square test, and there are some statistical significantly differences when P<0.05.Results 40 cases of postoperative PKRP were included and the pathology reported benign prostatic hyperplasia.The indicators are as follows:Ages of patients by the PKRP surgical treatment(72.3 ± 6.65) years, preoperative prostate size (101.05 ± 18.78) g, Qmax (7.25 ± 2.62) ml/s, residual urine volume (131.09 ± 139.63) ml, IPSS (19.97 ± 7.12), Total PSA (13.11 ± 12.31) ng/L, f/t PSA%(0.226 ± 0.082), preoperative hemoglobin (129.65 ± 11.58) g/L, preoperative Na+ (141.34 ± 2.62) mmol/L, operation time (112 ± 40.62) min, resection weight (60 ± 17.02) g, duration of hospital stay (25.475 ± 8.464) days, catheter removal(166.05 ± 91.09) h.1 cases after surgery for bleeding needed re-operation, and blood transfusion was required in 6 patients. No TUR syndrome was observed in these cases.Patients according to prostate volume are divided into two groups of 80-100g (n=23), more than 100g (n=17), and there had significant differences in resection weight (51.52 ± 11.02g vs.71.47 ± 17.21g), duration of hospital stays (23.17 ± 7.50d vs.28.59 ± 8.91d), and re-operation (0 vs.1) and blood transfusion (0 vs.6).35 patients completed follow-up by telephone, and follow-up time is 5-17 months postoperation. The IPSS score is 2.51 ± 1.15, and only one case described that erectile function is less favorable than preoperation. After discharge, there are no patients requiring surgery again, no patients with urinary incontinence and seven cases of patients with retrograde ejaculation. There are 20 cases of urinary tract infection.Conclusion PKRP for patients with benign prostatic hyperplasia (prostate volume greater than 80g) is safe and effective, and it apparently eliminated the risk of TUR syndrome by saline as intraoperative lavage. There is no influence to sexual function. PKRP is a promising form of treatment of large prostate. It should be more promotion and application in urologyPart Ⅲ Correlation between Bcl-2 Expression and Prostate Cancer risk in Chinese Population:A Meta-AnalysisObjective To systematically review the correlation between Bcl-2 expression and prostate cancer, as well as its clinicopathologic features in Chinese population.Methods Such databases as PubMed, Embase, CBM, CNKI, VIP, and WanFang Data were electronically searched from inception to February,2016 to collect case-control studies about the correlation between Bcl-2 expression and prostate cancer, as well as its clinicopathologic features in Chinese population. Two reviewers independently screened literature, extracted data and assessed the methodological quality of included studies. Then, meta-analysis was performed using RevMan 5.3 software.Results A total of 24 case-control studies were included, involving 1081 prostate cancer cases and 178 controls. The results of meta-analysis showed that the prostate cancer group had a higher Bcl-2 expression level when compared with the benign prostatic hyperplasia group (OR=3.27,95% CI 1.68 to 6.38, P=0.0005) or the control group (OR=3.77,95% CI 1.81 to 7.88, P=0.0004). Moreover, the expression level of Bcl-2 was higher in the low and medium differentiation group than in the high differentiation group (OR=3.60,95% CI 2.51 to 5.16, P<0.00001), higher in the stage of C+D than in the state of A+B (OR=2.17,95% CI 1.23 to 3.84, P=0.0008), and higher in the prostate cancer with metastasis than in the prostate cancer without metastasis (OR=4.02,95% CI 1.85 to 8.75, P=0.0005).Conclusion Current evidence suggests that the expression level of Bcl-2 is significantly correlated with prostate cancer and its clinicopathologic features in Chinese population. Due to limited quantity and quality of included studies, the above conclusions need to be verified by conducting more high quality and large sample size studies.Part Ⅳ Correlation between E-cadherin Expression and Prostate Cancer Risk in Chinese Population:A Meta-AnalysisObjective To evaluate the correlation between E-cadherin expression and prostate cancer, as well as its clinically pathologic features in Chinese population.Methods Such databases as PubMed, Embase, CBM, CNKI, VIP, and WanFang Data were searched from their inception to December,2015 to collect clinical studies about the correlation between E-cadherin expression and prostate cancer, as well as its clinically pathologic features in Chinese population. Two authors independently screened the publication according to the inclusion and exclusion criteria and extracted the information. The meta-analysis was performed using RevMan 5.3 software.Results A total of 21 studies were included, involving 920 prostate cancer cases,415 benign prostatic hyperplasia cases, and 48 normal prostate tissue specimens. The results of meta-analysis showed that, E-cadherin expression was statistically lower in the prostate cancer group than the benign prostatic hyperplasia group (OR=0.07,95% CI 0.05 to 0.11, P<0.01) and the normal prostate group (OR=0.04,95% CI 0.01 to 0.18, P<0.01), and it was decreased gradually with the increment of pathological differentiation and clinical stage of prostate cancer and with the decrement of lymph node or bone metastasis and serum PSA level.Conclusion Low expression of E-cadherin is notably correlated to prostate cancer and its clinically pathologic features in the Chinese population. Due to limited sample size and quality of included studies, the conclusion needs to be verified by conducting more high-quality studies.Part Ⅴ Correlation between Survivin Expression and Prostate Cancer risk in Chinese Population:A Meta-AnalysisObjective To evaluate the correlation between survivin expression and prostate cancer, as well as its clinically pathologic characteristics in Chinese population by meta-analysis.Methods Such databases as PubMed, Embase, CBM, CNKI, VIP, and WanFang Data were searched from their inception to November,2015 to collect case-control studies about the correlation between survivin expression and prostate cancer, as well as its clinically pathologic characteristics in Chinese population. Two authors independently screened the publication according to the inclusion and exclusion criteria, extracted the information, and assessed the methodological quality. Then the meta-analysis was performed using RevMan 5.3 software.Results A total of 32 case-control studies were included, involving 1613 prostate cancer cases,708 benign prostatic hyperplasia cases, and 93 normal prostate tissue specimens. The results of meta-analysis showed that, survivin expression was higher in the prostate cancer group than the benign prostatic hyperplasia group (OR=32.95,95% CI 19.88 to 54.63, P<0.00001), and in the prostate cancer group than the normal prostate group (OR=75.78, 95% CI 26.97 to 212.98, P<0.01); it was also higher in the low and medium differentiation group than the high differentiation group (OR=4.45,95% CI 3.13 to 6.32, P<0.01), in the stage of C+D than the state of A+B (OR 5.42,95% CI 2.91 to10.10, P<0.01), and in the prostate cancer with lymph node metastasis than without lymph node metastasis (OR 4.07, 95% CI 2.91 to 10.10, P<0.01).Conclusion Survivin protein expression is notably correlated to prostate cancer and its clinically pathologic features in the Chinese population. Due to limited sample size and quality of included studies, the conclusion needs to be verified by conducting more studies.