Objective To investigate the feasibil ity of prefabricating urethra in the expander capsule with gelatin sponge and micro-mucosa compound transplantation. Methods Eight 8-week-old Guizhou miniature pigs (male and/or female) weighing 20-25 kg were used. Six expanders (15 mL) were placed subcutaneously on the dorsal thorax of each miniaturepig. Autologous oral mucosa of every pig was harvested 2 weeks later to prepare micro-mucosa with a diameter less than 1 mm. Gelatin sponge 3 cm × 2 cm in size was transplanted to the expander capsule after being coated by the autologous micromucosa at the area expansion ratio of 4 ∶ 1 (group A), 8 ∶ 1 (group B), and 16 ∶ 1 (group C), respectively (n=2 per group). The implantation of gelatin sponge served as the blank control (group D, n=2). Physiological sal ine was injected into the expander immediately after operation, and the pressure in the expander was 40 mm Hg (1 mm Hg=0.133 kPa). The postoperative general condition of the animals was observed. At 1, 2, and 3 weeks after operation, the animals were killed to receive general, HE staining, and immunohistochemistry staining observations. Results All animals survived till the end of the experiment. The wounds healed well. General observation: in groups A, B, and C at 1 week after operation, there was no obvious degeneration of gelatin, the mucous was survived partially, and there were significant differences among three groups in terms of mucosa healing rate (P lt; 0.05), groups A and B were better than group C, and group A was better than group B; at 2 weeks, the gelatin sponge was partly absorbed, most of the mucosa survived, and the mucosa healing rate of groups A and B was better than that of group C (P lt; 0.05); at 3 weeks, the gelatin sponge was still not absorbed completely, the wound reached epithel ial ization approximately,and there were no significant differences among three groups in terms of mucosa heal ing rate (P gt; 0.05). No neo-mucosa was evident in group D at each time point. Histology and immunohistochemistry staining observation: at each time point, the mucosa epithel ium survival, inflammatory cell infiltration, and pan-cytokeratin were evident in groups A, B, and C; at 3 weeks after operation, the stratified squamous epithel ium presented obvious polarity and the submucous neovascularization was abundant in groups A, B, and C. There was no mucosa epithelium and positive stained pan-cytokeratin in group D. For the percentage of positive pan-cytokeratin stained area, there were significant differences among groups A, B, and C 1 week after operation (P lt; 0.05); at 2 and 3 weeks after operation, there was significant difference between group A and group C, and between group B and group C (P lt; 0.05); but no significant difference was evident between group A and group B (P gt; 0.05). Conclusion Micro-mucosa and gelatin spongy compound transplantation on the expander capsule can form mucosal l ining, achieve complete epithel ial ization in 2 weeks, and contribute to maintain the normal function of prefabricatied urethra.
Objective To investigate the histological and keratinous variation of prefabricated urethra in the capsule with micro-mucosa and gelatin sponge compound graft. Methods Five 8-week-old Guizhou miniature pigs (2 females and3 males) weighing 20-25 kg were used. Eight tissue expanders were bilaterally inserted into subcutaneous position on the dorsal thorax of each pig. Forty inserted expanders were randomized into two groups (n=20 per group). For the experimental group, the free buccal mucosa was cut into particles less than 1 mm in diameter, spread onto the gelatin sponge (3 cm × 2 cm) and then transplanted to the capsule; the area expansion ratio of autogenous micro-mucosa was 8 ∶ 1. For the control group, soft tissue expander without mucosa graft was implanted. The pressure in inserted expander was about 40 mm Hg (1 mm Hg=0.133 kPa). Inflation should be stopped when the injected sal ine volume reached 15 mL. The animals were killed 1 and 2 weeks and 1, 2, and 4 months after the implant to receive examination. Macroscope, histology, and immunohistochemistry changes were observed. Results All the animals survived to the end of the experiment and the wounds healed by first intention. There was no obvious degeneration of gelatin sponge, and some of the mucosa survived 1 week after implant. The gelatin sponge was partly absorbed, most of the mucosa survived 2 weeks after implant. Visual examination showed complete epithel ial ization of the entire cavity 1 month after implant. The experimental group at 2 and 4 months were similar to that of at 1 month in gross observations.The neo-mucosa was not found in the control group at different time points after implant. Histology examination revealed that compound implant was mainly infiltrated by inflammatory cells and the micro-mucosa survived well 1 week after implant in the experimental group. The stratified squamous epithel ium presented obvious polarity and the submucous neovascularization was abundant 2 weeks after implant. The compound implant achieved complete epithel ial ization 1 month after implant. The epithel ium degeneration occurred 2 months after implant. The stratified squamous epithel ium presented no abovious polarity 4 months after implant. No neo-mucosa was evident in control group at different time points. The experimental group was positive for the pan-cytokeratin staining at 1, 2 weeks, and 1, 2 months after implant, but negative at 4 months after implant The pan-cytokeratin staining was negative in the control group at different time points. Conclusion The buccal micromucosa and gelatin sponge compound graft can grow well on the expanded capsule 1 month after implant and the epithel ium degeneration is evident 2 months after implant. Environment of implanted mucosa has great influence on epithel ium mucosa.
Objective To review the study on adi pose derived stem cells (ADSCs) in the therapy of urological diseases. Methods The recent l iterature concerning ADSCs in bladder repair, urethral reconstruction, incontinence treatment, and erectile dysfunction treatment was reviewed. Results The appl ication of tissue engineering using ADSCs has made significant achievements in the treatment of urological diseases and in animal studies, and has been initially used in cl inicaland has achieved a good therapeutic effect. Conclusion Tissue engineering using ADSCs has good prospects in the study on urological diseases, and is expected to widely used in the treatment of urological diseases.
【摘要】 目的 探討采用不同方法經尿道前列腺等離子雙極電切術（plasmakinetic resection of prostate，PKRP）的方法及療效。 方法 2008年7月-2009年12月，應用不同方法行PKRP治療156例前列腺增生。患者年齡59~87歲，平均74歲。病程20 d~18年。前列腺重量22~100 g，平均38 g。采用單純順行電切法治療38例，部分剜除分割切除法治療76例，完全剜除法治療42例。 結果 156例手術均獲成功，手術時間平均90 min。獲得前列腺組織12~87 g，平均35 g。術后留置導尿管平均5.5 d，住院時間平均6.5 d。術后組織病理學診斷為良性前列腺增生152例，前列腺癌4例。拔除尿管后均能自主排尿，部分患者術后有尿道刺激癥狀；術后1個月內出現尿道外口狹窄3例，經尿道擴張治愈。隨訪時間1~12個月，平均6個月。短期尿失禁3例，時間分別為1周、1個月及3個月；無長期尿失禁。術后3個月國際前列腺癥狀評分（IPSS）癥狀評分平均減少24分，生活質量評分平均減少3分。 結論 PKRP安全、有效、并發癥少，可針對患者情況采用不同切割方法，效果更佳。【Abstract】 Objective To explore the effects and methods of transurethral plasmakinetic resection of prostate(PKRP). Methods A total of 156 patients with prostatic hyperplasia were treated with various methods of transurethral PKRP from July 2008 to December 2009. Patient’s age ranged from 59 to 87 years,74 years on average. The disease duration was 20 days to 18 years.Method one:anterograde resection in 38 patients; method two:partition retrograde enucleation in 76 patients; method three:completely retrograde enucleation in 42 patients. Results All of the swgeries were successful. The mean duration of the operation was 90 minutes.The collected prostatic specimens were 12-87 g,35 g on average. The mean catheter remaining dwation was 5.5 days.The mean postoperative hospital stay was 6.5 days. Conclusions PKRP is safe and effective. It is effective with various methods of transurethral plasmakinetic resection of prostate.
Objective To summarize the cl inical effect of a new operative technique of combining penis flap with buccal mucosa graft in the treatment of phall ical urethral stricture. Methods From March 2006 to December 2007, 6 patients with phall ical urethral stricture, aged 3-26 years old, were treated by the method of combining degloved penis flap with buccalmucosa graft. All of them had the symptom of dysuria within 2-10 months after urethroplasty. The urethral stent of highelasticity sil ica was kept for 2-3 weeks after operation. Results Five patients’ incisions obtained heal ing by first intention with satisfying urination and there were no compl ications. Sl ight infection appeared in 1 case at 3 days after operation, with small quantities of suppurative exudate in the incision, which healed through open drainage and washing with antibacterial 2 weeks later. The thinning of the urinary stream was presented at 1 month after operation, and then disappeared after 2-month urethral dilatation. All the 6 patients were followed up for 6-10 months and they felt satisfied with emiction. They had a l ittle bit thicker urinary streams than those of their own age. There was not any residual urine in bladder after emiction. Conclusion The method of combining penis flap with buccal mucosa graft is effective in the treatment of phall ical urethral stricture. It deserves to be popularized due to its simple operation and credible effects.
目的:探討微創治療BPH并發膀胱結石的方法。方法:應用氣壓彈道碎石術聯合TURP治療BPH并發膀胱結石26例。結果:24例一次成功,1例一期碎石,二期行TURP;1例中轉開放手術。結論:氣壓彈道碎石術聯合TURP治療BPH并發膀胱結石創傷小,恢復快,安全高效。
【摘要】 目的 探討經尿道超脈沖等離子體腔內逆行剜除汽化切除術治療良性前列腺增生的有效性和安全性。 方法 2008年4月－2009年4月，應用Gyrus超脈沖等離子體行經尿道前列腺腔內逆行剜除汽化切除術124例，前列腺重量為（62.3±21.7） g。術中首先用電切鏡鞘、電切環鈍銳性相結合將前列腺增生腺體沿外科包膜逆行剝離、剜除，同時斷血供，然后推至膀胱頸處后切除。統計手術時間、術中出血量及收集到的前列腺組織質量，術后留置尿管時間、住院時間、手術后前列腺特異性抗原（prostatic specific antigen，PSA）、殘余尿量（post voiding residual volume，PVR）、最大尿流率（Qmax）、國際前列腺癥狀評分（international prostatic symptom scores，IPSS）及生活質量評分（quality of life，QOL）等指標的變化。 結果 124例手術順利完成。手術時間（48.1±19.4） min，腺體組織質量（57.6±19.6） g，平均失血量（86.2±20.7） mL，僅1例需要輸血，出血量和手術時間隨前列腺體積和重量的增加而相應增加和延長。術后留置尿管時間（3.1±1.6） d，住院時間（5.8±1.4） d。隨訪6～18個月，所有患者術后1、6個月Qmax、PVR、IPSS、QOL均較術前得到改善，與術前比較差異均有統計學意義（Plt;0.05）。術后6個月血清PSA降至（0.90±0.26） ng/mL，與術前比較差異有統計學意義（Plt;0.05）。繼發尿道外口狹窄3例，經尿道擴張治療后恢復排尿通暢；繼發尿失禁2例，經保守治療分別于術后1～6個月恢復；無永久性尿失禁、再次手術止血患者，無手術死亡者，未發生經尿道前列腺電切綜合征。 結論 經尿道超脈沖等離子體腔內逆行剜除汽化切除術治療良性前列腺增生安全有效，值得臨床推廣使用。【Abstract】 Objective To evaluate the safety and clinical efficacy of superpulse plasmakinetic body in transurethral intracavitary retrograde enucleation and vaporization resection of the prostate (TUEVRP) for the treatment of benign prostatic hyperplasia (BPH). Methods Between April 2008 and April 2009, Gyrus TUEVRP was performed on 124 patients with obstructive BPH whose mean prostatic weight was (62.3±21.7) g. The hyperplasia prostate glands were retrogradely dissected and enucleated along surgical capsule to the bladder neck by sharp and blunt dissection combination of the resectoscope tip or loop. Simultaneously, the blood supply of the gland was clamped. The changes of such indexes as operating time, perioperative blood loss, collected prostatic specimen weight, postoperative catheterization time, hospitalization time, prostatic specific antigen (PSA), post voiding residual volume (PVR), maximum urinary flow rate (Qmax), international prostatic symptom score (IPSS), and quality of life (QOL) were assessed. Results All surgeries were successfully carried out with an average operation time of (48.1±19.4) minutes ranged from 25 to 175 minutes. The mean collected prostatic specimen weight was (57.6±19.6) g ranged from 20.2 to 125.7 g. The blood loss was ranged from 45 to 350 ml, averaging at (86.2±20.7) mL during the operation. Blood transfusion was needed in only one case. Blood loss and operation time were increased and prolonged in accordance with the increase of prostatic volume and weight. The postoperative catheterization time was ranged from 2 to 5 days, averaging at 3.1±1.6. The mean hospitalization time was (5.8±1.4) days ranged from 5 to 8 days. All patients were followed up for 6 to 18 months. Qmax, PVR, IPSS and QOL-score six months after operation were significantly improved compared with those before operation (Plt;0.05). There were three cases of external urethral stricture, and they were treated with urethral dilatation successfully. Two cases of urinary incontinence recovered 1 and 6 months later, respectively, by traditional treatment. There were no cases of permanent urinary incontinence, reoperation for hemostasis, operative death, or transurethral resection syndrome. Conclusion TUEVRP is safe and clinically efficacious in the treatment of BPH, and is worthy of clinical promotion.