Objective: To evaluate the effectiveness and safety of sacral neuromodulation(SNM)in the treatment of non-neurogenic and non-obstructive dysuria in elderly patients. Methods: Six elderly patients with non-neurogenic and non-obstructive(2 males and 4 females)treated with SNM were recruited from multiple medical centers across the country in this retrospective study from January 2012 to December 2016.All patients received two or more conservative treatments including behavior therapy, oral therapy, etc., with no good effect.Data of the average residual urine volume, average urine volume, maximum urine volume, average urinary frequency and quality of life score before operation, after implantation of stage Ⅰ tined lead, and at the end of follow-up after implantation of stage Ⅱ implanted pulse generator(IPG)were compared. Results: The average age in the 6 patients was 69.5(65~79)years.The results of SNM treatment showed that the objective findings and/or subjective symptoms in all patients were significantly improved in more than 50% of indexes before treatment.All patients chose embedding of IPG at the end of stage Ⅰ, with 100.0% of the conversion rate from stage Ⅰ to stage Ⅱ.The curative effect was stable in general.At stages of baseline, personal experience and end of follow-up respectively, the average residual urine volumes were(161.7±110.2)ml, (70.0±52.2)ml, and(50.0±44.7)ml, the average urine volume were(105.0±74.0)ml, (163.3±93.1)ml, and(155.0±92.3)ml, and the maximum urine volume were(146.7±81.2)ml, (216.7±93.1)ml, and(206.7±112.7)ml, which showed continuously significant improvements with patients' great satisfaction.The mean duration of fellow-up in 6 cases was 17.5 months(7-57 months). No severe adverse reactions such as wound infection, electrode dislocation and hematoma were observed. Conclusions SNM treatment is safe and effective for elderly patients with non-neurogenic and non-obstructive dysuria who are refractory to other treatments.SNM has a stable medium-term curative effect and a high-transfer-rate from stage Ⅰ to stage Ⅱ, which is appropriate for non-neurogenic and non-obstructive dysuria.The duration of SNM may be positively correlated with the improvement of residual urine volume and urination frequency.

Objective To investigate an initial therapeutic effect and safety of an implantation of artificial urinary sphincter(AUS)for treatment of male incontinence.Methods Clinical data of 5 male patients hospitalized in our center from November 2013 to November 2017 and treated with AUS were retrospectively analyzed.The usage of pads and the improvement of relevant score were compared before and after operation.Results The 5 males had incontinence secondary to post-prostatectomy,aged 71-78 years with an average of 75.4 years.All AUS devices were successfully activated and manipulated.After implantation,patients were followed up for a mean of 28.4 months.A social continence was got in four cases,a totally dry in one case.Complications occurred in 2 cases:1 case had mechanical failure and reached the standard of social urine control after replacing devices;another case had an unknown cause.Conclusions AUS implantation is a safe and effective treatment for male patients with the moderate to severe urinary incontinence.

Objective:To evaluate the efficacy and safety of robotic arm assisted laparoscopic hysterosacral fixation in patients with pelvic organ prolapse(POP), and its impact on lower urinary tract function.Methods:This study retrospectively analyzed the clinical data of POP patients who had undergone robotic arm assisted laparoscopic hysterosacral fixation at our center from June 2019 to October 2020, and conducted exploratory research.Results:A total of 6 patients were included in the study, with POP quantitative staging above stage Ⅲ.The ages ranged from 70 to 82 years.The number of births each patient had given ranged from 1 to 3, & all were via vaginal deliveries.There were no significant changes in urodynamic parameter scores in any patients before and after surgery, but half of the patients had detrusor overactivity before surgery, which all disappeared after surgery.In addition, synchronous X-ray images showed that the postoperative pelvic organs were closer to the normal anatomical position.At the same time, quantitative staging of POP had achieved clear improvement, and related scale scores also significantly improved.One patient complained of occasional lumbar and back discomfort with postoperative over-stretching during outpatient review, which improved after symptomatic treatment.Conclusions:robotic arm assisted Laparoscopic hysterosacral fixation is satisfactory in efficacy and safety for POP patients, with good postoperative restoration of the uterus to the anatomical position and has insignificant influence on the function of the lower urinary tract.It is worth further assessment for wide application.

This study prospectively collected the clinical data of patients who received sacral neuromodulation(SNM)variable-frequency stimulation (VFS) mode from June 2020 to December 2020, in order to explore the efficacy and safety of VFS mode in the treatment of refractory lower urinary tract dysfunction. The inclusion criteria were as follows: ①SNM was implanted; ②age ≥18 years old; ③The traditional constant-frequency stimulation (CFS) mode has poor therapeutic effect, and can not be improved after repeated adjustment of stimulation parameters; ④Patients with overactive bladder (OAB) symptoms, who fail to respond to conservative treatment or are intolerant to conservative treatment; ⑤The drugs that affect the lower urinary tract symptoms and pelvic function should not be increased or decreased during the trial; ⑥provision of informed consent. A total of six patients meeting the criteria were included in the study, with three males and three females. The age ranged from 47 to 74 years, with an average age of 55 years. Among those patients, three cases were diagnosed of OAB, two cases were diagnosed of interstitial cystitis, and one case was diagnosed of neurogenic bladder. All patients had received CFS-SNM for an average of 20.6 months before upgrading to VFS mode, and suffered from severe frequency of urination at the same time. Compared with the severity of symptoms during the baseline period and the CFS period, a trend of improvement was found among four patients during the VFS period. The severity of symptoms was mainly based on the average daily urination frequency and OAB-Q score. For the two patients with interstitial cystitis, OAB symptoms worsened during the VFS period, while the VAS score did not change significantly. In general, VFS-SNM is not inferior to CFS-SNM in improving the symptoms of frequent micturition. For patients with interstitial cystitis, multiple sets of VFS parameters can be tried under the premise of satisfactory pain management.

Objective:To evaluate the feasibility, safety and efficacy of the magnetic resonance imaging guided focused ultrasound surgery (MRgFUS) in the treatment of localized prostate cancer (PCa).Methods:The data of 5 patients treated by MRgFUS from August 2020 to June 2021 in our institution were retrospectively analyzed. The median age was 73 (58-80) years, with the median PSA of 7.34 (5.19-8.40) ng/ml, and a median prostate volume of 27.96 (21.50-37.91) ml. The median pretreatment international prostate symptom score (IPSS) was 13(0-18). Of the 3 patients with intention of erectile function preservation, the pretreatment international index of erectile function-15 (IIEF-15) score was 12, 23 and 3, respectively. All patients had histopathology-proven PCa of grade group ≤ International Society of Urological Pathology (ISUP) 3, pre-operative PSA level <20 ng/ml, and a clinical stage ≤T 2b. A total of 6 lesions was confirmed by biopsy, with 3 of ISUP grade group 3 and 3 of ISUP grade group 1. All 5 patients underwent MRgFUS which was guided by a real-time magnetic resonance imaging (MRI). PSA, MRI and repeated biopsy were conducted to monitor recurrence. Questionnaires consisted of IPSS, IIEF-15, and the International Consultation on Incontinence-questionnaire-Short Form (ICI-Q-SF) were recorded before and after MRgFUS to evaluate the impact on functional preservation. Results:A total of 5 patients received MRgFUS. In total, 5 of the 6 lesions were treated. 1 lesion unvisible on MRI was not clinically significant and was left untreated. The median time in MRI scanner was 190 (140-355) min, and the median sonication time was 64 (35-148) min with the median sonications of 8 (5-13). The median catheter indwelling time was 1 (1-8) days. No other adverse effects were reported. The PSA level of all 5 patients decreased, with the nadir PSA of 1.196 ng/ml, 4.398 ng/ml, 4.135 ng/ml, 1.562ng/ml and 1.350ng/ml, respectively. 4 of the patients had a PSA decrease over 50%. No PCa lesion was seen on MRI at 3-month follow-up visit. As for functional preservation, the post-MRgFUS IPSS declined compared with the baseline score, and the IPSS of last follow-up was 5(0-14). Of the 3 patients with intention to preserve the erectile function, the erectile function score of IIEF-15 were 12, 30 and 9 three months after the treatment, respectively. No incontinence occurred postoperatively.Conclusions:MRgFUS is a feasible and safe way for the treatment of low- to intermediate-risk localized PCa, with satisfactory performance on functional preservation and low incidence of complications. The oncological outcomes still need to be establised with longer follow-up time and larger sample studies.

Objective:To investigate the clinical features, diagnosis, treatment and prognosis of primary urethral carcinoma.Methods:The clinical and follow-up data of 12 patients with primary urethral carcinoma admitted to Beijing Hospital from July 2016 to December 2020 were retrospectively analyzed.Results:There were four males and eight females, with an average age of 66.3(53~75)years.Nine patients underwent magnetic resonance examination before operation, and eight patients presented with abnormal urethral signals.The clinical stage of female patients was generally later than those of male patients, and all patients received surgical treatment.Four male patients did not receive post-operative adjuvant treatment, and all of them attained disease-free survival.Among the eight female patients, four patients received postoperative adjuvant radiotherapy or chemotherapy, five patients had recurrence or metastasis during follow-up, and two patients died.Conclusions:The clinical stage of female urethral cancer is later than that of male.MRI examination is beneficial to the determination of local invasion of urethral cancer.For female proximal urethral cancer and male posterior urethral cancer, radical resection has a good therapeutic effect.

Objective:To explore the potential relationship of urethral pressure profilometry and the complications of artificial urethral sphincter (AUS) implantation.Methods:The clinical data of patients who underwent AUS implantation in Beijing Hospital from March 2019 to March 2022 were retrospectively analyzed. All the patients were male. The average course of disease was 43.1 months(ranging 11-120 months). The average age was (68.6±13.2) years. The median number of pads used was 4.5 (3.0, 6.0). The preoperative maximum urethral pressure (MUP) was (84.6±25.5) cmH 2O, and the maximum urethral closure pressure (MUCP) was 51.0 (41.0, 74.0) cmH 2O. AUS implantation was performed through a single perineal incision in all patients. The sleeve size was mainly determined by the measured urethral circumference of the patient. After installation of all components, the urethral pressure profilometry was performed under the state of device inactivation and activation. The pump was activated 6 weeks after the operation, and telephone follow-up was performed 3 months after the activation of the device. The urinary control and complications were recorded. The results of follow-up were compared with the results of urethral pressure profilometry, and the preliminary conclusions were drawn. Results:In this study, 3 patients (20%) received 4.0cm cuffs, 10 patients (66.7%) received 4.5cm cuffs, and 2 patients (13.3%) received 5.0cm cuffs. The MUP and MUCP of AUS device in inactivated state were (82.5±30.2) cmH 2O and 51.0(48.0, 77.0) cmH 2O. In the activated state, MUP was (138.9±21.7) cmH 2O and MUCP was 109.0(94.0, 133.0) cmH 2O. Compared with that before operation, the urethral pressure in the inactivated state did not increase significantly (all P > 0.05), while the urethral pressure in the activated state increased significantly (all P < 0.001). The patients were followed-up for 3-33 months. Thirteen patients (86.7%) used the initial installation device, and all of them met the standard of social continence. One patient died of cerebrovascular accident. One patient took out the device due to urethral erosion. The incidence of complications was 26.7% (4/15), including painless hematuria in 2 cases, scrotum and penis infection in 1 case, and urethral erosion in 1 case. The MUP and MUCP of these patients were (100.0 ± 40.7) cmH 2O and (80.8 ± 39.7) cmH 2O respectively. In the intraoperative active state, the MUP was (151.5 ± 15.3) cmH 2O and the MUCP was (123.0 ± 17.2) cmH 2O. The MUP of the other 3 patients in the device activation state was significantly higher than the average value, and all of them were above 150 cm H 2O, except one patient who was infected due to cognitive problems and chronic urinary retention. In 11 patients without complications, the MUP and MUCP were (76.1±24.7) cmH 2O and (55.1±20.0) cmH 2O respectively. In the intraoperative active state, the MUP was (134.4±22.5) cmH 2O and the MUCP was (108.5±29.8) cmH 2O. Conclusions:AUS implantation has a definite curative effect. Poor comprehension, and MUP higher than 150 cmH 2O in the activated state of the device may be risk factors for complications.

Objective:To investigate the detection rate and the characteristics of detected prostate cancer foci on multi-parametric MRI (mp-MRI) and to evaluate the potential influence factors.Methods:A total of 66 patients undergoing radical prostatectomy (RP) from August 2017 to July 2019 in Beijing Hospital were retrospectively studied. The median age was 67(56-80)years, with the median preoperative PSA level of 8.73 (1.22-72.46)ng/ml, and median prostate volume of 35.9(16.8-131.8) ml. All patients underwent mp-MRI before surgery and the whole mount section of RP specimens was prepared. Two radiologists reviewed all the foci independently and then matched each foci with an urological pathologist. The primary outcome was the detection rate of prostate cancer. The potential influence factors were also investigated.Results:Of all 66 patients, a total of 62(93.9%) patients were diagnosed with prostate cancer on a preoperative mp-MRI. On whole mount section, 109 prostate cancer foci were detected, of which 77 foci were correctly diagnosed on mp-MRI, with the overall sensitivity of 70.6%. For all the foci detected, 53(48.6%) were grade group 1 disease of International Society of Urological pathology (ISUP), 31(27.5%) were ISUP grade group 2 disease, 19(17.4%) were ISUP grade group 3 disease, and 6(5.5%) were ≥ISUP grade group 4 disease. Mp-MRI detected 62/67(92.5%) lesions with tumor diameter ≥1 cm, 49/56(87.5%) lesions with tumor Gleason score ≥7, and 59/66(89.4%) index lesions. The tumor diameter( OR=3.183, 95% CI 1.580-6.411, P=0.001)and index lesion status( OR=4.042, 95% CI 1.127-14.503, P=0.032)were independently associated with the detection of prostate cancer foci on mp-MRI. Conclusions:mp-MRI is an effective technique for prostate cancer detection. Sensitivity increased with increased tumor size and index lesion status. The tumor diameter and index lesion status were independently associated with the detection of prostate cancer foci on mp-MRI.

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