1.Analysis of the impact of high progesterone ovulation induction protocols on embryo euploidy rates and clinical pregnancy outcomes in infertile patients
Minjie WANG ; Yongjing ZHANG ; Jin QIAN ; Chao WANG ; Yuping XU ; Tianjuan WANG ; Dawei CHEN ; Yan HAO ; Qiong XING
Acta Universitatis Medicinalis Anhui 2026;61(5):923-930
ObjectiveTo analyze the effects of the progestin-primed ovarian stimulation (PPOS) protocol on embryo euploidy rate and clinical pregnancy outcomes in infertile patients. MethodsWomen who underwent Preimplantation genetic testing for aneuploidy (PGT-A) cycles were selected as study participants (a total of 656 cycles and 3 081 blastocysts). Participants were divided into two age groups (≤35 years and >35 years) and further stratified by ovarian stimulation protocol: the Progestin-Primed Ovarian Stimulation (PPOS) group (n=48 and 60, respectively), the Luteal Phase Long Protocol (LP) group (n=160 and 57, respectively), and the Gonadotropin-Releasing Hormone Antagonist Protocol (AP) group (n=220 and 111, respectively). Baseline characteristics, ovarian stimulation outcomes, and embryo development parameters were compared among the three protocols within each age group. Additionally, clinical pregnancy outcomes of the first frozen embryo transfer (FET) cycle were compared. The primary outcome measure was the embryo euploidy rate. Results① In the ≤35 years age group, baseline follicle-stimulating hormone (bFSH) levels were significantly higher in the PPOS group compared to the LP and AP groups, and the bFSH/bLH ratio was significantly higher in the PPOS group than in the AP group (P < 0.05). In the >35 years age group, bFSH levels in both the PPOS and AP groups were significantly higher than in the LP group (P < 0.05).② In the ≤35 years group, there were no significant differences in the rates of metaphase II (MII) oocytes, 2-pronuclei (2 PN) zygotes, cleavage, 2 PN cleavage, blastocyst formation, high-quality embryos, or embryo euploidy between the PPOS group and either the LP or AP groups. However, the PPOS group showed significantly lower values for the following parameters compared to the other two groups: total oocytes retrieved, number of MII oocytes, number of 2 PN zygotes, number of cleaved embryos, number of 2 PN cleaved embryos, number of blastocysts formed, number of high-quality embryos, number of high-grade blastocysts, number of transferable embryos, number of cryopreserved embryos, number of biopsied blastocysts, number of euploid embryos, and the rate of obtaining at least one euploid embryo. In the >35 years group, no significant differences were observed among the PPOS, LP, and AP groups in the rates of MII oocytes, 2 PN cleavage, blastocyst formation, or in the number of euploid embryos, euploidy rate, and the rate of obtaining at least one euploid embryo. However, the PPOS group had significantly lower numbers of total oocytes retrieved, MII oocytes, 2 PN zygotes, cleaved embryos, 2 PN cleaved embryos, blastocysts formed, transferable embryos, and cryopreserved embryos compared to the LP group (P<0.05). The high-quality embryo rate was significantly lower in the PPOS group than in the AP group (P<0.05). The numbers of high-quality embryos, high-grade blastocysts, and biopsied blastocysts were significantly lower in the PPOS group than in both the LP and AP groups (P<0.05). Notably, the 2 PN fertilization rate was significantly higher in the PPOS group than in the AP group, and the cleavage rate was significantly higher in the PPOS group than in both the LP and AP groups (P<0.05).③ No significant differences were found among the three groups in the biochemical pregnancy rate, clinical pregnancy rate, live birth rate, early miscarriage rate, and late miscarriage rate following the first FET cycle. ConclusionCompared to the other two protocols, the PPOS protocol does not significantly affect embryo euploidy or clinical pregnancy rates. However, in freeze-all cycles with PGT-A, the PPOS protocol does not reduce the rate of chromosomally normal embryos but may decrease the total number of available embryos. It may not be the optimal choice for younger women, but it can be considered as a viable option for women of advanced maternal age.
2.The impact of hysteroscopy on the outcomes of embryo transfer in preimplantation genetic testing
Jinling XIA ; Yan HAO ; Dawei CHEN ; Ping ZHOU
Acta Universitatis Medicinalis Anhui 2026;61(9):1641-1646
ObjectiveTo evaluate the impact of hysteroscopic examination and subsequent management on reproductive outcomes in embryo transfer cycles among patients undergoing preimplantation genetic testing (PGT). MethodsThis retrospective analysis included 261 transfer cycles from in vitro fertilization (IVF) and 267 transfer cycles from PGT. Among IVF cycles, 134 underwent hysteroscopy prior to embryo transfer (IVF-H group), while 127 did not (IVF-N group). Among PGT cycles, 140 received hysteroscopy before transfer (PGT-H group), and 127 did not (PGT-N group). We compared general characteristics and pregnancy outcomes between the IVF-H and IVF-N groups, as well as between the PGT-H and PGT-N groups. ResultsNo significant differences were observed in maternal age, body mass index, or baseline hormone profiles between the IVF-H and IVF-N groups, nor between the PGT-H and PGT-N groups. The IVF-H group showed higher rates of biochemical pregnancy, clinical pregnancy, and live birth, along with a lower early miscarriage rate, compared with the IVF-N group. However, these differences did not reach statistical significance (P>0.05). In the PGT cohort, the PGT-H group had significantly higher biochemical and clinical pregnancy rates than the PGT-N group (P<0.05). Early miscarriage rates were comparable between the PGT-H and PGT-N groups (P>0.05). Although the live birth rate was higher in the PGT-H group than in the PGT-N group, the difference was not statistically significant (P>0.05). ConclusionHysteroscopic evaluation before embryo transfer may be associated with improved clinical pregnancy and live birth rates. This benefit appears more pronounced in patients undergoing PGT compared with those receiving conventional IVF treatment.
3.Management of severe glottis exposure difficulty during suspension laryngoscopic surgery
Dingyuan XU ; Li FU ; Ke LÜ ; Xin MA ; Bin WANG ; Dawei HAO ; Guangke WANG
China Journal of Endoscopy 2025;31(4):86-90
Objective Summarize the clinical application and elevating the caudal end of suspension laryngoscope to deal with severe glottis exposure difficulties.Method A retrospective analysis was conducted on the clinical data of 25 patients with severe dystotic glottic exposure(Cormack-Lehane grade Ⅲ or Ⅳ)who underwent laryngoscopy support surgery from January 2021 to January 2024,then analyze the intraoperative management and outcomes.Results In all the patients,after the angle of the suspension laryngoscope was adjusted to the maximum and the glottis could not be exposed satisfactorily,the caudal end of the suspension laryngoscope stent was lifted to obtain a larger tilt angle and field of view.After the caudal end of the stent was elevated by(11.50±6.31)cm,the glottis was exposed satisfactorily in 23 cases and the operation was performed successfully;In 2 cases,the laryngeal mask airway was used in conjunction with a fibrolaryngoscope and laryngeal forceps were used to extract the lesion step by step.Pharyngeal mucosal tearing and oozing of blood occurred in 24 cases,and the bleeding stopped after electrocoagulation;one case had loose and dislodged teeth.There were no significant changes in blood pressure and heart rate of patients before and after stent lifting(P>0.05).Conclusion For the severe difficulty of glottis exposure during suspension laryngoscopic surgery,it can be dealt with by lifting the caudal end of the stent,which is a simple and effective method that does not cause serious complications and is worth clinical application.
4.Improvement mechanism of Pangshi antai zhixue decoction on spontaneous abortion with heat syndrome by regulating NLRP3 inflammasome
Liya MA ; Xingfei WU ; Liujun WU ; Yanduo SHEN ; Bingheng XIE ; Jiale ZHANG ; Jinhao HAO ; Meng YU ; Yumiko NAKAYAMA ; Minghao ZHANG ; Dawei ZHANG
China Pharmacy 2025;36(1):37-43
OBJECTIVE To investigate the mechanism of Pangshi antai zhixue decoction in the improvement of spontaneous abortion with heat syndrome by regulating the NOD-like receptor protein 3 (NLRP3) inflammasome.METHODS The binding activities of 13 main components in Pangshi antai zhixue decoction with NLRP3,apoptosis-associated speck-like protein containing a CARD (ASC),and caspase-1 precursor (pro-caspase-1) were predicted by molecular docking.Sixty 1-day-old pregnant rats were randomly divided into normal group,model group,dexamethasone group (0.002 g/kg),and Pangshi antai zhixue decoction low-,medium-,and high-dose groups (11.025,22.05,44.10 g/kg),with 10 rats in each group.Each group was given distilled water/corresponding medicinal solution intragastrically,once a day,for 12 consecutive days.Except for normal group,other groups were given traditional Chinese medicine for warming yang and mifepristone to establish a model of spontaneous abortion with heat syndrome.24 h after the last medication,serum levels of triiodothyronine (T3),thyroxine (T4),interleukin-2 (IL-2),IL-4,IL-6,IL-10,and interferon-γ (IFN-γ) were all detected;the abortion rate and uterine coefficient were calculated;the pathological morphology of the pregnant uterus was observed;protein expressions of NLRP3,ASC and caspase-1 were detected.RESULTS The molecular docking results showed that the binding energies of 13 main components of Pangshi antai zhixue decoction with NLRP3,ASC,and pro-caspase-1 were all less than-5 kJ/moL.The animal experiment results showed that compared with normal group,the uterine coefficient and serum levels of IL-4,IL-6 and IL-10 were decreased significantly in model group (P<0.05);the abortion rate and serum levels of T3,T4,IL-2 and IFN-γ as well as protein expressions of NLRP3,ASC and caspase-1 were increased significantly (P<0.05);there were abortion lesions in the pregnant endometrium.Compared with the model group,most of the quantitative indicators mentioned above were significantly reversed in Pangshi antai zhixue decoction groups (P<0.05),and the endometrial miscarriage lesions in pregnancy were improved to varying degrees.CONCLUSIONS Pangshi antai zhixue decoction influences the immune balance between mother and fetus by regulating the formation of NLRP3 inflammasome,down-regulating pro-inflammatory cytokines such as IFN-γ and IL-2,and up-regulating anti-inflammatory cytokines such as IL-4,IL-6 and IL-10,thereby improving spontaneous abortion with heat syndrome.
5.Analysis of diagnosis and treatment of granulomatous prostatitis
Yirui WEI ; Dawei XIE ; Weifeng HE ; Hao WANG ; Pushen YANG ; Jianwen WANG
Chinese Journal of Urology 2025;46(9):698-703
Objective:To investigate the clinical diagnosis and treatment of granulomatous prostatitis(GP)in patients with Prostate Imaging Reporting and Data System(PI-RADS)scores ≥ 4 on magnetic resonance imaging(MRI).Methods:The data of 12 GP patients with PI-RADS score ≥ 4 who were admitted to Beijing Chaoyang Hospital,Capital Medical University,from February 2015 to February 2025,were retrospectively analyzed. The patients were aged 51?73 years(mean 66 years). Presenting complaints included elevated prostate-specific antigen(PSA)levels in 6 cases,prostatic mass in 2 cases,urinary retention in 3 cases,and gross hematuria in 1 case. All 12 patients had concomitant lower urinary tract symptoms. Medical history revealed pulmonary tuberculosis in 2 cases,testicular tuberculosis in 1 case,close contact with tuberculosis in 1 case(spouse diagnosed with pulmonary tuberculosis 5 years earlier),allergic granulomatous vasculitis in 1 case,and intravesical bacillus Calmette-Guérin(BCG)instillation in 1 case. Digital rectal examination(DRE)showed gradeⅠprostatic hyperplasia in 2 cases,grade Ⅱ in 9 cases,and grade Ⅲ in 1 case. Nodules were palpable in 6 patients. The median PSA was 7.20 ng/ml(ranging 1.11?21.90 ng/ml),with 2 cases < 4 ng/ml. Transrectal ultrasound was performed in 10 patients,and prostate volumes were ranging from 29.48 to 109.78 cm3,with 6 cases > 45 cm3. All 12 patients underwent MRI,and all demonstrated PI-RADS scores ≥ 4,typically presenting as low signal intensity on T2-weighted imaging,high signal on diffusion-weighted imaging(DWI),and low apparent diffusion coefficient(ADC)values. Contrast-enhanced MRI in 8 cases revealed heterogeneous enhancement. One patient underwent 68Ga-prostate-specific membrane antigen positron emission tomography-computed tomography( 68Ga-PSMA PET-CT),which showed band-like increased uptake in the central zone. All 12 patients were preoperatively suspected of prostate cancer,of whom 10 underwent transrectal biopsy and 2 underwent transperineal biopsy. Pathological characteristics and follow-up results were analyzed. Treatment outcomes were analyzed,The International Prostate Symptom Score(IPSS),quality of life(QOL)score,maximum urinary flow rate(Q max),and post-void residual urine(PVR)volume were compared before and 1 month after treatment. Results:Histopathology confirmed GP in all cases,with chronic inflammation in 11 cases and acute inflammation in 1 case. Immunohistochemistry demonstrated positivity for CD68(macrophage marker),high-molecular weight cytokeratin(HCK),and reticulin staining;periodic acid-Schiff(PAS)and acid-fast staining were positive in 2 cases,corresponding to 1 patient with a prior history of pulmonary tuberculosis and 1 with testicular tuberculosis. Two patients underwent thulium laser enucleation of the prostate,while 10 received conservative treatment,including 2 patients with tuberculosis infection who were referred for anti-tuberculosis therapy and 8 patients treated with oral tamsulosin 0.2 mg once daily. Follow-up was completed in 10 patients:9 were followed for 1 ? 3 months(mean 2.4 months),and 1 patient was followed for 9 years before being diagnosed with prostate cancer. Two additional patients,whose pathological findings suggested a possible diagnosis of tuberculous granulomatous prostatitis,were advised to undergo anti-tuberculosis treatment at another hospital and were subsequently lost to follow-up. Among the 2 patients who underwent thulium laser enucleation,IPSS decreased from 26 and 25 to 6 and 5 respectively,QOL scores decreased from 6 and 5 to 1 and 0 respectively,Q max increased from 4.5 and 4.3 ml/s to 23.0 and 21.9 ml/s respectively. In the 8 patients treated conservatively,IPSS decreased from 18.45±7.17 to 14.45±5.03,and QOL score decreased from 5.09±1.04 to 4.09±0.70 at 1 month after treatment,showing significant improvement( P < 0.05). Additionally,one patient initially diagnosed with GP and managed conservatively remained stable for 9 years,but subsequently developed urinary retention and underwent thulium laser enucleation,with postoperative pathology confirming prostate cancer. Conclusions:Clinical manifestations of GP are nonspecific,and the condition can easily be mistaken for prostate cancer due to elevated PSA levels and PI-RADS scores ≥4. Some patients may present with acute urinary retention,but definitive diagnosis still relies on prostate biopsy and immunohistochemistry. Treatment should be individualized according to the underlying etiology,with medication as the mainstay,while transurethral surgical intervention may be considered in cases with obstruction. Although GP is a benign lesion,its potential association with prostate cancer warrants vigilance and emphasizes the importance of long-term follow-up.
6.Analysis of factors affecting fibrosis reversal in patients with metabolic associated steatohepatitis based on magnetic resonance elastography
Ziyi ZHANG ; Chenglin SUN ; Hao REN ; Dawei YANG ; Xinyu ZHAO ; Mengyang ZHANG ; Xiao HAN ; Jingjie ZHAO ; Qianyi WANG ; Yameng SUN ; Xinyan ZHAO ; Jidong JIA ; Zhenghan YANG ; Xiaofei TONG ; Hong YOU
Chinese Journal of Hepatology 2025;33(10):1001-1008
Objective:To dynamically assess liver fibrosis using magnetic resonance elastography (MRE) and explore factors associated with fibrosis reversal in patients with metabolic dysfunction-associated steatohepatitis (MASH).Methods:This study included data from patients diagnosed with MASH by liver biopsy who underwent at least two MRE examinations. Patients were divided into a fibrosis reversal group and a non-reversal group according to whether MRE values decreased by 20% during follow-up. Differences in clinical data between the groups were compared using analysis of variance, the Kruskal-Wallis test, and the chi-square test. Univariate and multivariate logistic regression analyses were used to explore independent risk factors for fibrosis reversal in MASH.Results:A total of 46 cases were included in this study (mean age 50.1±12.3 years, BMI 26.1±3.1 kg/m2). Among them, the reversal group accounted for 26.1%. The rate of decrease in MRI proton density fat fraction (PDFF) was significantly higher in the reversal group (-50.0% vs. -8.1%, P=0.001) than in the non-reversal group between the two MRE examinations. The reversal group showed a more significant change rate of decreases in fasting insulin (-37.3% vs. -3.6%, P=0.011), insulin resistance index (-38.6% vs. -6.5%, P=0.044), and ALP (-24.9% vs. 0, P=0.004). Multivariate logistic regression analysis indicated that the rate of change in MRI PDFF was an independent predictor of fibrosis reversal ( OR=0.96, 95% CI: 0.92-1.00, P=0.046). Conclusion:A decrease in MRI proton density fat fraction levels is independently associated with liver fibrosis reversal in MASH, suggesting that intervention targeting liver fat content may be an effective treatment strategy.
7.Laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis versus laparoscopic total colectomy with ileorectal anastomosis for slow transit constipation: a multicenter retrospective cohort study
Yang LUO ; Taotao HOU ; Yifei MU ; Chundi MIAO ; Tingyue GONG ; Jun QIN ; Dongyang WANG ; Dawei SONG ; Hao LI ; Shaolan QIN ; Rong CUI ; Tingfeng WANG ; Ming ZHONG ; Minhao YU
Chinese Journal of Gastrointestinal Surgery 2025;28(12):1426-1433
Objective:To compare postoperative anal function recovery between laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis and laparoscopic total colectomy with ileorectal anastomosis for slow transit constipation.Methods:This multicenter retrospective cohort study enrolled patients meeting the following criteria: (1) severe constipation symptoms (<2 bowel movements/week), absent or insignificant defecation urge, abdominal distension, requiring laxatives to maintain bowel movements or laxatives being ineffective; (2) constipation symptoms for over 5 years, ineffective after >2 years of medical treatment, with strong desire for surgery; (3) significantly prolonged colon transit time (>72 hours) without significant gastric or small intestinal transit dysfunction; (4) no organic colonic lesions confirmed by colonoscopy and abdominal CT. Exclusion criteria: (1) patients undergoing open surgery; (2) exclusion of outlet obstruction constipation (e.g., rectocele, rectal prolapse, puborectalis spasm) by functional defecation MRI; (3) comorbid psychiatric disorders; (4) missing clinical data or loss to follow-up (postoperative follow-up <24 months). Based on these criteria, clinical and follow-up data were collected from 220 patients who underwent either laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis (LSC group, n = 115) or laparoscopic total colectomy with ileorectal anastomosis (LTC group, n = 105) for slow transit constipation between January 2013 and December 2022. Subjective anal function (Constipation Severity Score and Wexner Fecal Incontinence Score) and objective anal function (positive rate of rectoanal inhibitory reflex [RAIR] and anorectal manometry) were observed preoperatively and at 6, 12, and 24 months postoperatively. Results:No significant differences were found in baseline characteristics between the two groups (all P >0.05). All surgeries were completed successfully without major significant complications. Subjective anal function assessment: At 24 months postoperatively, Constipation Severity Scores decreased significantly compared to preoperative scores in both groups [LSC group: (25.2±2.8) vs. (2.9±1.8), P <0.001; LTC group: (25.8±2.9) vs. (2.8±1.9), P<0.001]. No significant differences were found between the groups at 6, 12, and 24 months postoperatively (all P>0.05). Wexner Fecal Incontinence Scores at 24 months were significantly lower than those at 6 months in both groups [LSC group: (12.9±1.8) vs. (3.9±2.5), P<0.001; LTC group: (12.6±1.8) vs. (5.4±2.4), P<0.001]. Although no significant difference was found at 6 months ( P = 0.190), the LSC group had significantly lower Wexner scores than the LTC group at 12 and 24 months postoperatively (both P < 0.001). Objective anal function assessment: (1) Positive RAIR rate: Preoperative positive RAIR rates were 33.0% (38/115) in the LSC group and 25.7% (27/105) in the LTC group ( P > 0.05). At 24 months, positive rates increased significantly in both groups [LSC: 66.1% (76/115); LTC: 63.8% (67/105)] compared to preoperative rates (both P<0.001), but no significant differences were found between groups at 6, 12, and 24 months (all P>0.05). (2) Resting pressure (RP) and squeeze pressure (SP): No significant differences were found in preoperative RP and SP between groups (all P>0.05). The LSC group had significantly higher RP and SP than the LTC group at 6 and 12 months postoperatively (all P<0.05), but no significant differences were found at 24 months ( P>0.05). Conclusion:Both laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis and laparoscopic total colectomy with ileorectal anastomosis are safe for patients with slow transit constipation. However, laparoscopic subtotal colectomy with antiperistaltic cecorectal anastomosis offers superior postoperative anal function recovery.
8.The effect of endometriosis on pregnancy and delivery outcomes in cycles of single frozen euploid blastocyst transfer
Yuanyuan Zhang ; Dehuan Huang ; Yan Hao ; Dawei Chen ; Ping Zhou ; Yunxia Cao
Acta Universitatis Medicinalis Anhui 2025;60(8):1548-1554
Objective:
To investigate the impact of endometriosis on pregnancy and delivery outcomes in patients undergoing single euploid frozen_thawed blastocyst transfer cycles following preimplantation genetic testing.
Methods :
A retrospective analysis was performed on clinical data from patients undergoing frozen_thawed blastocyst transfer after preimplantation genetic testing at the reproductive center of The First Affiliated Hospital of Anhui Medical University. The endometriosis group comprised 84 treatment cycles. After 1 : 3 propensity score matching , 252 treatment cycles from non_endometriosis patients were included as the control group. General characteristics and clinical outcomes were compared between the two groups.
Results:
There were no statistically significant differences between the two groups in terms of general characteristics , human chorionic gonadotropin ( HCG) positive rate , cycle clinical pregnancy rate per cycle , early miscarriage rate , preterm birth rate , live birth rate per cycle , cesarean section rate , delivery weeks , cumulative clinical pregnancy rate , and cumulative live birth rate (all P > 0. 05) .
Conclusion
Endometriosis may not reduce the pregnancy rate and live birth rate in single frozen euploid blastocyst transfer cycles .
9.Efficacy of baricitinib combined with ruxolitinib cream in the treatment of six patients with progressive nonsegmental vitiligo: a clinical observation
Tingting ZHU ; Weiran LI ; Zhaobing PAN ; Hao LIU ; Xianfa TANG ; Caihong ZHU ; Hequn HUANG ; Dawei DUAN ; Ruochen ZHANG ; Xiaojian CHEN ; Yang WANG ; Qian XUE ; Jurui ZHANG ; Lijing YANG ; Xuejun ZHANG ; He HUANG ; Bo ZHANG
Chinese Journal of Dermatology 2025;58(9):856-859
Objective:To evaluate the efficacy and safety of baricitinib combined with ruxolitinib cream in the treatment of progressive nonsegmental vitiligo.Methods:Clinical data were retrospectively collected from patients with progressive nonsegmental vitiligo in Boao Super Hospital. All the patients were treated with oral baricitinib daily (2 mg/day for patients weighing ≤ 50 kg; 4 mg/day for those > 50 kg) in combination with topical application of ruxolitinib cream twice daily for 24 consecutive weeks. Disease severity was assessed using the facial vitiligo area scoring index (F-VASI) and total body VASI (T-VASI) at baseline, week 12, and week 24. Adverse reactions were monitored throughout the treatment course.Results:Six patients with progressive nonsegmental vitiligo were collected, including 3 males and 3 females, aged 26 - 42 years, with the disease duration ranging from 0.5 to 25 years. At week 12, 3 patients achieved a 50% ~ < 75% improvement in facial vitiligo lesions (F-VASI 50), 1 patient achieved F-VASI 75 (75% ~ < 90% improvement), and 1 patient achieved T-VASI 50; at week 24, 4 patients achieved F-VASI 50, 1 patient achieved F-VASI 75, 1 patient achieved F-VASI 90 (≥ 90% improvement), and 3 patients achieved T-VASI 50. During the treatment, upper respiratory infection occurred in 1 patient, acne in 1 patient, pruritus in 2 patients, elevation of total cholesterol levels in 2 patients, and increase of high-density lipoprotein levels in 2 patients. No severe adverse events were observed during the treatment.Conclusion:The combination therapy with baricitinib and ruxolitinib cream may have potential efficacy and safety in the treatment of progressive nonsegmental vitiligo.
10.Analysis of diagnosis and treatment of granulomatous prostatitis
Yirui WEI ; Dawei XIE ; Weifeng HE ; Hao WANG ; Pushen YANG ; Jianwen WANG
Chinese Journal of Urology 2025;46(9):698-703
Objective:To investigate the clinical diagnosis and treatment of granulomatous prostatitis(GP)in patients with Prostate Imaging Reporting and Data System(PI-RADS)scores ≥ 4 on magnetic resonance imaging(MRI).Methods:The data of 12 GP patients with PI-RADS score ≥ 4 who were admitted to Beijing Chaoyang Hospital,Capital Medical University,from February 2015 to February 2025,were retrospectively analyzed. The patients were aged 51?73 years(mean 66 years). Presenting complaints included elevated prostate-specific antigen(PSA)levels in 6 cases,prostatic mass in 2 cases,urinary retention in 3 cases,and gross hematuria in 1 case. All 12 patients had concomitant lower urinary tract symptoms. Medical history revealed pulmonary tuberculosis in 2 cases,testicular tuberculosis in 1 case,close contact with tuberculosis in 1 case(spouse diagnosed with pulmonary tuberculosis 5 years earlier),allergic granulomatous vasculitis in 1 case,and intravesical bacillus Calmette-Guérin(BCG)instillation in 1 case. Digital rectal examination(DRE)showed gradeⅠprostatic hyperplasia in 2 cases,grade Ⅱ in 9 cases,and grade Ⅲ in 1 case. Nodules were palpable in 6 patients. The median PSA was 7.20 ng/ml(ranging 1.11?21.90 ng/ml),with 2 cases < 4 ng/ml. Transrectal ultrasound was performed in 10 patients,and prostate volumes were ranging from 29.48 to 109.78 cm3,with 6 cases > 45 cm3. All 12 patients underwent MRI,and all demonstrated PI-RADS scores ≥ 4,typically presenting as low signal intensity on T2-weighted imaging,high signal on diffusion-weighted imaging(DWI),and low apparent diffusion coefficient(ADC)values. Contrast-enhanced MRI in 8 cases revealed heterogeneous enhancement. One patient underwent 68Ga-prostate-specific membrane antigen positron emission tomography-computed tomography( 68Ga-PSMA PET-CT),which showed band-like increased uptake in the central zone. All 12 patients were preoperatively suspected of prostate cancer,of whom 10 underwent transrectal biopsy and 2 underwent transperineal biopsy. Pathological characteristics and follow-up results were analyzed. Treatment outcomes were analyzed,The International Prostate Symptom Score(IPSS),quality of life(QOL)score,maximum urinary flow rate(Q max),and post-void residual urine(PVR)volume were compared before and 1 month after treatment. Results:Histopathology confirmed GP in all cases,with chronic inflammation in 11 cases and acute inflammation in 1 case. Immunohistochemistry demonstrated positivity for CD68(macrophage marker),high-molecular weight cytokeratin(HCK),and reticulin staining;periodic acid-Schiff(PAS)and acid-fast staining were positive in 2 cases,corresponding to 1 patient with a prior history of pulmonary tuberculosis and 1 with testicular tuberculosis. Two patients underwent thulium laser enucleation of the prostate,while 10 received conservative treatment,including 2 patients with tuberculosis infection who were referred for anti-tuberculosis therapy and 8 patients treated with oral tamsulosin 0.2 mg once daily. Follow-up was completed in 10 patients:9 were followed for 1 ? 3 months(mean 2.4 months),and 1 patient was followed for 9 years before being diagnosed with prostate cancer. Two additional patients,whose pathological findings suggested a possible diagnosis of tuberculous granulomatous prostatitis,were advised to undergo anti-tuberculosis treatment at another hospital and were subsequently lost to follow-up. Among the 2 patients who underwent thulium laser enucleation,IPSS decreased from 26 and 25 to 6 and 5 respectively,QOL scores decreased from 6 and 5 to 1 and 0 respectively,Q max increased from 4.5 and 4.3 ml/s to 23.0 and 21.9 ml/s respectively. In the 8 patients treated conservatively,IPSS decreased from 18.45±7.17 to 14.45±5.03,and QOL score decreased from 5.09±1.04 to 4.09±0.70 at 1 month after treatment,showing significant improvement( P < 0.05). Additionally,one patient initially diagnosed with GP and managed conservatively remained stable for 9 years,but subsequently developed urinary retention and underwent thulium laser enucleation,with postoperative pathology confirming prostate cancer. Conclusions:Clinical manifestations of GP are nonspecific,and the condition can easily be mistaken for prostate cancer due to elevated PSA levels and PI-RADS scores ≥4. Some patients may present with acute urinary retention,but definitive diagnosis still relies on prostate biopsy and immunohistochemistry. Treatment should be individualized according to the underlying etiology,with medication as the mainstay,while transurethral surgical intervention may be considered in cases with obstruction. Although GP is a benign lesion,its potential association with prostate cancer warrants vigilance and emphasizes the importance of long-term follow-up.


Result Analysis
Print
Save
E-mail