Beyond prostate, beyond surgery and beyond urology: The “3Bs” of managing non-neurogenic male lower urinary tract symptoms

Lower urinary tract symptoms(LUTS),consisting storage,voiding and postmicturition symptoms,is a comprehensive definition involving symptoms that may occur due to several causes.Instead of simply focusing on the enlarged prostate,more attention has to be paid to the entire urinary tract as well as multiple system comorbidities.Therefore,prostate surgery alone does not necessarily provide adequate management and cross-disciplinary collaborations are sometimes required.Based on current literature,this paper proposes the“3Bs”concept for managing non-neurogenic male LUTS,namely,“beyond prostate”,“beyond surgery”and“beyond urology”.The clinical application of the“3Bs”enables urologists to carry out integrated,individualized and precise medical care for each non-neurogenic male LUTS patient.

Robotic assisted andrological surgery

The introduction of the operative microscope for andrological surgery in the 1970s provided enhanced magnification and accuracy, unparalleled to any previous visual loop or magnification techniques. This technology revolutionized techniques for microsurgery in andrology. Today, we may be on the verge of a second such revolution by the incorporation of robotic assisted platforms for microsurgery in andrology. Robotic assisted microsurgery is being utilized to a greater degree in andrology and a number of other microsurgical fields, such as ophthalmology, hand surgery, plastics and reconstructive surgery. The potential advantages of robotic assisted platforms include elimination of tremor, improved stability, surgeon ergonomics, scalability of motion, multi-input visual interphases with up to three simultaneous visual views, enhanced magnification, and the ability to manipulate three surgical instruments and cameras simultaneously. This review paper begins with the historical development of robotic microsurgery. It then provides an in-depth presentation of the technique and outcomes of common robotic microsurgical andrological procedures, such as vasectomy reversal, subinguinal varicocelectomy, targeted spermatic cord denervation （for chronic orchialgia） and robotic assisted microsurgical testicular sperm extraction （microTESE）.

Quality of life after colorectal surgery:A prospective study of patients compared with their spouses

BACKGROUND Although radical surgery for colorectal cancer improves the oncological outcomes,a significant portion of patients suffer from alterations in their quality of life(QoL).There are many studies investigating the QoL of patients who have colorectal cancer but none of these focus on the QoL of spouses.AIM To compare the QoL of patients after colorectal surgery to the QoL of spouses.METHODS This prospective study consisted of patients who were married and who underwent surgery at the University of Ankara,Department of Surgery between March 2006 and November 2010.Patients’spouses were also enrolled.The study was approved by the Ethics Committee of the Faculty of Medicine,Ankara University,and all patients provided written informed consent.The study included patients who underwent curative surgery for colorectal carcinoma[n=100;abdominoperineal excision(n=33),low anterior resection(n=33),left hemicolectomy(n=34)]and their spouses(n=100).The patients and spouses completed the Medical Outcome Study 36-item Short Form Survey(SF-36)and the World Health Organization Disability Assessment Schedule II(WHODAS-II)preoperatively and at postoperative months 15 to 18.RESULTS During this 4.5-year study period,273 patients with sigmoid or rectal cancer were admitted to the hospital.Of these patients,119 were eligible and willing to participate.Eleven patients had either systemic or locally inoperable disease,three patients had a severe surgical complication,and five patients were lost to followup.Therefore,a total of 100 patients completed the follow-up period.There was a statistically significant positive correlation between the disability scores of patients and the scores of their spouses for some of the WHODAS-II subscales,such as“self-care,”“life activities,”and“participation in society,”as well as for the total WHODAS-II score.There was also a positive correlation between the QoL of patients and the QoL of their spouses in most of the SF-36 subscales.Statistically significant correlations were observed for the“bodily pain,”“general health,””vitality,”“social function,”“emotion,”“mental health,”and mental component summary score subscales of the SF-36.When gender differences were evaluated,the QoL of male patients’spouses changed more when compared with female patients’spouses for all of the WHODAS-II subscales.Colorectal cancer surgery has a significant effect on the QoL of both patients and their spouses,these effects were more significant among male patients’spouses.CONCLUSION Preoperative counseling regarding potential problems should therefore collectively address patient and their spouse as a couple rather than the patient alone,particularly for patients undergoing low anterior resection and abdominoperineal resection procedures.

Fertility outcomes following bariatric surgery

Obesity impacts human health in more than one way.The influence of obesity on human reproduction and fertility has been extensively examined.Bariatric surgery(BS)has been used as an effective tool to achieve long-term weight loss in both sexes.BS improves hormonal profiling,increasing the odds of spontaneous pregnancy and success rates following assisted reproductive techniques in infertile females.For obese males,BS does improve sexual function and hormonal profile;however,conflicting reports discuss reduced sperm parameters following BS.Although the benefits of BS in the fertility field are acknowledged,many areas call for further research,like choosing the safest surgical techniques,determining the optimal timing to get pregnant,and resolving the uncertainty of sperm parameters.

Radiological Evaluation of Lower Genitourinary Tract Cysts in Males

Aim of the Work: The present wok aims to assess how to reach the optimum diagnosis of the nature and the complications of lower genitourinary tract cyst in male patient using different radiological imaging modalities. Patients and Methods: 1000 male patients were evaluated with pelvic ultrasound and if lower genitourinary tract cysts were present, the patients were further subjected to either trans-rectal ultrasound (TRUS), TRUS guided aspiration for presence of spermatozoa, TRUS guided seminal vesiculography or CT urography in order to reach the origin of the cyst and the complications of its presence. Results: 14 cases were detected with lower genitourinary tract cysts among our patients with an overall incidence 1.4%;among them 3 patients with mid line prostatic cysts showed normal seminal analysis;1 patient with prostatic cyst was infertile;3 patients were detected with infravesical cysts after transurethral resection prostatectomy;2 cases with small retention cysts were associated with benign prostatic hyperplasia;1 case was detected with prostatic abscess;1 patient was detected with unilateral ureterocele;1 patient was detected with large pelvi abdominal unilateral seminal vesicle cyst;1 patient was with unilateral ejaculatory duct cyst;1 patient with small cystic dilation of prostatic urethra was associated with urethral stone.

Enhanced recovery after surgery in transurethral surgery for benign prostatic hyperplasia

Enhanced recovery after surgery(ERAS)measures have not been systematically applied in transurethral surgery for benign prostatic hyperplasia(BPH).This study was performed on patients with BPH who required surgical intervention.From July 2019 to June 2020,the ERAS program was applied to 248 patients,and the conventional program was applied to 238 patients.After 1 year of follow-up,the differences between the ERAS group and the conventional group were evaluated.The ERAS group had a shorter time of urinary catheterization compared with the conventional group(mean±standard deviation[s.d.]:1.0±0.4 days vs 2.7±0.8 days,P<0.01),and the pain(mean±s.d.)was significantly reduced through postoperative hospitalization days(PODs)0-2(POD 0:1.7±0.8 vs 2.4±1.0,P<0.01;POD 1:1.6±0.9 vs 3.5±1.3,P<0.01;POD 2:1.2±0.7 vs 3.0±1.3,P<0.01).No statistically significant difference was found in the rate of postoperative complications,such as postoperative bleeding(P=0.79),urinary retention(P=0.40),fever(P=0.55),and readmission(P=0.71).The hospitalization cost of the ERAS group was similar to that of the conventional group(mean±s.d.:16927.8±5808.1 Chinese Yuan[CNY]vs 17044.1±5830.7 CNY,P=0.85).The International Prostate Symptom Scores(IPSS)and quality of life(QoL)scores in the two groups were also similar when compared at 1 month,3 months,6 months,and 12 months after discharge.The ERAS program we conducted was safe,repeatable,and efficient.In conclusion,patients undergoing the ERAS program experienced less postoperative stress than those undergoing the conventional program.

9852例男性不育患者精液质量及其影响因素分析

目的分析9852例男性不育患者的精液参数,探讨男性不育患者精液质量及其影响因素。方法选取2018年1月至2022年12月就诊于温州市中医院的9852例男性不育患者,分析精液参数包括精液外观、精液量、黏稠度、凝集度、液化时间、pH值、精子浓度、精子总数、精子总活动率[前向运动精子(PR)+非前向运动精子(NP)]、PR和正常形态精子百分率。按检测年份、患者年龄、禁欲天数进行分组,分析精液常规指标,并与同期本院体检已生育男性673名(对照组)进行比较。采用多元线性回归分析患者感染状况、生活习惯和职业特点等因素对精液参数的影响。结果不育组精液异常率结果从高到低依次为:正常形态精子百分率、PR、黏稠度、pH值、液化时间、精子总活动率、精子浓度、精子总数、精液量和凝集度。不育组的pH值、液化时间、精子浓度、精子总数、精子总活动率、PR、正常形态精子百分率均低于对照组,差异均有统计学意义(均P<0.01)。2018—2022年不同检测年份的精子浓度、精子总数和正常精子形态百分率呈逐年下降趋势,差异均有统计学意义(均P<0.05);不同年龄分组中,随着患者年龄增长,精子总数、精子总活动率和PR随之降低,差异均有统计学意义(均P<0.001);不同禁欲天数分组中,患者精子浓度、精子总活动率、精子总数和PR的差异均有统计学意义(均P<0.05)。多元线性回归分析,前列腺炎、解脲脲原体感染、吸烟、饮酒、温热以及刺激气味环境与精子浓度、精子总数、精子总活动率、PR和正常精子形态百分率有关;久坐与精子总活动率、PR和正常精子形态百分率有关。结论2018—2022年男性不育患者精子浓度、精子总数和正常形态精子百分率呈逐年下降趋势;年龄、禁欲天数、泌尿生殖道感染(前列腺炎、解脲脲原体感染)、不良的生活习惯(吸烟、饮酒、久坐)和职业暴露(温热、刺激气味环境)可能是影响不育男性精液质量的因素。

Phalloplasty following penectomy for penile cancer

Objective:Penile reconstruction or phalloplasty following penectomy can be offered where the functional penile length is inadequate for a man to void while standing or to have sexual intercourse.Phalloplasty is usually staged due to the complex surgical techniques required.This narrative review describes the technical concepts and summarises the contemporary outcomes following phalloplasty in this challenging cohort.Methods:A retrospective review of the English literature was performed between January 1946 till November 2021.The data were synthesised and complemented by the expert opinion of the authors with 20 years of experience in this field.The flaps are ideally designed with an integrated urethra or alternatively,a further free flap urethroplasty can be offered.Phallo-plasty is further complicated following penectomy by scarring from the previous surgery and the potential loss of structures that would normally be present at the recipient site.Results:There are limited published data with a total of 19 men recorded in the literature.Only the radial artery forearm free flap and anterolateral thigh flap have been described in this cohort of patients.Functional outcomes including standing micturition,sensation in the neo-phallus,and the ability to orgasm are good.Overall quality of life and satisfaction was also good despite the high risk for long-term complications of the neophallus and donor site.Conclusion:Phalloplasty following penectomy requires microsurgical transfer of a free flap or a pedicled flap to reconstruct a neophallus.An erectile device is inserted at a later stage to facilitate sexual intercourse,if desired.Surgical scarring from penectomy and the potential loss of vasculature that would normally be present at the recipient site may further complicate reconstruction.Surgical and functional outcomes are acceptable based on the limited published experience to date.

1990~2019年中国男性泌尿与生殖系统肿瘤疾病负担变化及预测分析

目的:分析及预测1990~2019年中国男性泌尿及生殖系统肿瘤中前列腺癌、睾丸癌、肾癌和膀胱癌的疾病负担变化。方法:全球疾病负担数据库中选择1990~2019年中国男性前列腺癌、睾丸癌、肾癌和膀胱癌的发病、死亡与疾病负担数据,运用Joinpoint回归模型计算疾病负担的变化趋势,ARIMA模型对发病情况进行预测。结果:1990~2019年中国男性前列腺癌、肾癌、膀胱癌、睾丸癌的标化发病率及患病率均处于上升水平,睾丸癌标化发病率和患病率增幅最高,分别增长了326.79%和1070.93%;前列腺癌疾病负担最高,2019年其标化发病率、患病率、死亡率分别为17.34/10万、117.65/10万、7.79/10万;肾癌的标化死亡率与DALY率明显上升,分别增长了103.59%和103.17%。2019年前列腺癌、肾癌和膀胱癌发病率、死亡率和DALYs率最高的年龄段均为90~94岁,患病率最高的年龄段为70~89岁;睾丸癌患病率最高的年龄段为25~49岁。ARIMA模型预测显示,2020~2029年中国男性前列腺癌、睾丸癌、肾癌和膀胱癌的标化发病率仍呈上升趋势。结论:中国男性前列腺癌、睾丸癌、肾癌、膀胱癌的疾病负担呈上升趋势,其中年轻男性该系统疾病负担上升显著,提示年轻人群泌尿生殖系统肿瘤的防治问题应进一步关注;预测到2029年,标化发病率均有所上升。

Dose surgical sub-specialization influence survival in patients with colorectal cancer?

AIM:To perform a review of patients with colorectal cancer to a community hospital and to compare the risk-adjusted survival between patients managed in general surgical units versus a colorectal unit. METHODS:The study evaluated all patients with colorectal cancer referred to either general surgical units or a colorectal unit from 1/1996 to 6/2001.These results were compared to a historical control group treated within general surgical units at the same hospital from 1/1989 to 12/1994.A Kaplan- Meier survival analysis compared the overall survivals (all- cause mortality) between the groups.A Cox proportional hazards model was used to determine the influence of a number of independent variables on survival.These variables included age,ASA score,disease stage,emergency surgery, adjuvant chemotherapy and/or radiotherapy,disease location,and surgical unit. RESULTS:There were 974 patients involved in this study. There were no significant differences in the demographic details for thethree groups.Patients in the colorectal group were more likely to have rectal cancer and Stage Ⅰ cancers, and less likely to have Stage Ⅱ cancers.Patients treated in the colorectal group had a significantly higher overall 5-year survival when compared with the general surgical group and the historical control group (56 % versus 45 % and 40 % respectively,P<0.01).Survival regression analysis identified age,ASA score,disease stage,adjuvant chemotherapy,and treatment in a colorectal unit (Hazards ratio:0.67;95 % CI:0.53 to 0.84,P =0.0005),as significant independent predictors of survival. CONCLUSION:The results suggest that there may be a survival advantage for patients with colon and rectal cancers being treated within a specialist colorectal surgical unit.

男性泌尿生殖系统淋巴瘤临床病理分析

目的:探讨男性泌尿生殖系统淋巴瘤的临床病理特征和免疫表型。方法:回顾性分析35例男性泌尿生殖系统淋巴瘤的病理形态学和免疫组化标记,结合文献对其临床病理特点进行分析。结果:35例淋巴瘤患者的年龄4～83岁,平均年龄56.5岁,≥50岁者28例(80%)。发生于睾丸者最多,28例(80%),其次是前列腺3例(8.6%),精索、精囊、阴茎和附睾各1例(各2.9%)。组织学类型包括:弥漫性大B细胞淋巴瘤(DLBCL)22例(62.9%)、粘膜相关淋巴组织(MALT)淋巴瘤6例(17.1%)、Burkitt淋巴瘤4例(11.4%)、外周T细胞淋巴瘤2例(5.7%)和浆细胞瘤1例(2.9%)。结论:男性泌尿生殖系统淋巴瘤少见,多发生于中老年人,大多是B细胞淋巴瘤,以DLBCL最常见,其次是MALT淋巴瘤、Burkitt淋巴瘤,T细胞淋巴瘤和浆细胞瘤罕见,男性泌尿生殖系统淋巴瘤的确诊依赖组织病理学,免疫组化标记对明确诊断、分型和鉴别诊断具有肯定价值。

阴道毛滴虫粘附与吞噬男性泌尿生殖道上皮细胞的电镜观察

目的 :观察阴道毛滴虫对男性泌尿生殖道上皮细胞的粘附与吞噬 ,探讨男性滴虫病的致病机制。 方法 :培养的虫体与男性泌尿生殖道上皮细胞孵育 ,透射电镜观察超微结构。 结果 :虫体呈阿米巴样粘附上皮细胞 ;虫体靠伪足及体表凹陷 ,来包绕、蚕食上皮细胞局部。 结论 :阴道毛滴虫对男性泌尿生殖道上皮细胞具有粘附性与吞噬性。

头孢曲松钠与左氧氟沙星治疗男性淋球菌感染效果对比

目的:分析并探讨头孢曲松钠与左氧氟沙星治疗男性泌尿生殖器急性淋球菌感染的临床效果。方法:选取2012年1月至2016年1月医院接受治疗的男性泌尿生殖器急性淋球菌感染患者160例,随机分为A组与B组。A组给予头孢曲松钠治疗,B组给予左氧氟沙星治疗。结果:A组有效率为97.5%,B组有效率为83.9%,A组有效率高于B组(P<0.05)。A组不良反应发生率为10.0%,B组不良反应发生率为22.5%。A组不良反应发生率低于B组(P<0.05)。A组痊愈时间为(9.12±2.32)d,复发率为3.9%。B组痊愈时间为(13.25±2.64)d,复发率为16.3%。A组痊愈时间短于B组,且复发率低于B组(P<0.05)。结论:头孢曲松钠与左氧氟沙星治疗男性泌尿生殖器急性淋球菌感染的临床效果显著,复发率低,且不良反应少,值得推广。

前列腺癌根治术后尿失禁的处理

目的:探讨前列腺癌根治术后并发尿失禁的处理方法。方法:报告31例经外科手术和非手术综合治疗前列腺癌根治术后尿失禁患者的临床资料。结果:手术治疗7例,尿失禁处理有效率为100%;非手术综合治疗26例,24例有效,有效率为92.3%。结论:对轻度或不完全性尿失禁(1,2度)采用盆底肌锻炼、生物反馈和电刺激、药物治疗等非手术综合治疗效果好,对重度或完全性尿失禁(3度)则需手术治疗。

世界首例单孔腹腔镜下男假两性畸形整形术

目的探讨单孔腹腔镜(laparoendoscopic single-sitesurgery,LESS)下男假两性畸形整形术,包括LESS行下乙状结肠阴道成形术、双侧隐睾切除术及开放式外阴整形手术对男假两性畸形的疗效。方法患者为17岁,社会性别为女性,基因性别为男性,要求实现女性性别。行LESS下乙状结肠阴道成形术、双侧隐睾切除及开放式外阴整形手术,于脐下缘取2.5cm弧形切口,置入自制(2环1套法)单孔多通道开口器建立手术入路。手术过程包括LESS下双侧隐睾切除术、乙状结肠阴道成形术及开放式会阴部整形术。结果手术总时间7h,LESS部分3.5h。术中没有增加其它手术通道或者中转开放手术。术中失血约400ml,围手术期未发生水电解质平衡紊乱及酸碱失衡。术后6月复查,新阴道生长良好,无明显挛缩,固定适当,会阴部外形构建良好。结论 LESS手术创伤小,恢复快,对两性畸形的美容效果十分明显,有望成为治疗两性畸形的更加微创、美观的手术方法 。

女性泌尿生殖道瘘的手术治疗(附58例报告)

目的：探讨提高女性泌尿生殖道瘘疗效的措施。方法：对58例膀胱阴道尿道瘘患者，经膀胱镜检查和亚甲蓝试验等确诊。除2例留置导尿管后瘘口自行闭合、3例肿瘤复发未行手术外，53例于膀胱阴道尿道瘘发生后3～8个月行手术修补。其中18例取经阴道手术径路，35例经腹和膀胱手术径路。结果：53例手术均成功，无并发症；术后随访3～6个月，无复发。结论：恨据患者具体情况、瘘孔的性质及术者经验，选择手术时间和手术径路，可提高女性泌尿生殖道瘘的修复效果。

Long term recurrence,pain and patient satisfaction after ventral hernia mesh repair

AIM: To compare long term outcomes of laparoscopic and open ventral hernia mesh repair with respect to recurrence, pain and satisfaction.METHODS: We conducted a single-centre follow-up study of 194 consecutive patients after laparoscopic and open ventral hernia mesh repair between March 2000 and June 2010. Of these, 27 patients(13.9%) died and 12(6.2%) failed to attend their follow-up appointment. One hundred and fifty-three(78.9%) patients attended for follow-up and two patients(1.0%) were interviewed by telephone. Of those who attended the follow-up appointment, 82(52.9%) patients had received laparoscopic ventral hernia mesh repair(LVHR) while 73(47.1%) patients had undergone open ventral hernia mesh repair(OVHR), including 11 conversions. The follow-up study included analyses of medical records, clinical interviews, examination of hernia recurrence and assessment of pain using a 100 mm visual analogue scale(VAS) ruler anchored by word descriptors. Overall patient satisfaction was also determined. Patients with signs of recurrence were examined by magnetic resonance imaging or computed tomography scan.RESULTS: Median time from hernia mesh repair to follow-up was 48 and 52 mo after LVHR and OVHR respectively. Overall recurrence rates were 17.1% after LVHR and 23.3% after OVHR. Recurrence after LVHR was associated with higher body mass index. Smoking was associated with recurrence after OVHR. Chronic pain(VAS > 30 mm) was reported by 23.5% in the laparoscopic cohort and by 27.8% in the open surgery cohort. Recurrence and late complications were predictors of chronic pain after LVHR. Smoking was associated with chronic pain after OVHR. Sixty point five percent were satisfied with the outcome after LVHR and 49.3% after OVHR. Predictors for satisfaction were absence of chronic pain and recurrence. Old age and short time to follow-up also predicted satisfaction after LVHR.CONCLUSION: LVHR and OVHR give similar long term results for recurrence, pain and overall satisfaction. Chronic pain is frequent and is therefore important for explaining dissatisfaction.

Devine矫正术治疗小儿单纯性隐匿阴茎

目的 总结Devine矫正术治疗隐匿阴茎的疗效。 方法 采用Devine术治疗单纯性隐匿阴茎 9例 ,年龄5～ 14岁。 7例为肥胖患儿 ,其中 1例曾行阴茎体固定术失败 ,3例曾用绒毛膜促性腺激素治疗无效。 结果 本组手术后阴茎均显著外露 ,凸出 2～ 3cm。随访 3～ 6个月 ,阴茎无明显回缩 ,勃起功能正常。 结论 隐匿阴茎多因肉膜层发育异常所致。采用Devine矫正术充分切除失去弹性的肉膜层 ,松解阴茎 。

输尿管镜下钬激光治疗男性尿道狭窄及闭锁(附31例报告)

目的探讨输尿管镜下钬激光治疗男性尿道狭窄及闭锁的效果。方法2006年1月～2007年3月收治男性尿道狭窄及闭锁病人31例,狭窄段长0.5～3.0 cm,采用输尿管镜下钬激光狭窄段切开治疗。术后留置尿管平均4（2～6）周。结果所有手术均成功,拔除尿管后排尿通畅,尿线粗,无尿失禁,无阳痿,无尿瘘。尿流率由术前平均6.1（3.2～10.0）ml/s提高到21.6（15.4～24.5）ml/s。随访3～12个月,均排尿良好,无再狭窄发生,B超检查无剩余尿。结论输尿管镜下钬激光切开治疗男性尿道狭窄及闭锁安全有效,近期治疗效果良好,手术创伤小,并发症少,值得推广应用。由于随访时间尚短,其长期疗效需进一步观察。

男性不育伴精索静脉曲张的治疗策略

男性不育伴精索静脉曲张的治疗选择困难,争议较大,在制定医疗决策中要考虑到患者的求治目的是生育,解决问题的办法不仅仅是手术,还应该包括药物和辅助生殖技术,而且3种治疗方法还可以彼此协同。在选择具体治疗方法的时候,要充分考虑到精索静脉与精液质量是否存在相关性,术后睾丸功能改善的概率有多大,药物治疗能否有效地控制病情,不育患者年龄是否过大等相关因素。