Yunxiang Xiao

Correlation of ASA Grade and the Charlson Comorbidity Index With Complications in Patients After Transurethral Resection of Prostate

OBJECTIVE To re-assess the Charlson Comorbidity Index (CCI) and the American Society of Anesthesiologists Physical Status Classification System (ASA grade) as predictive factors of complications after transurethral resection of prostate. METHODS This study retrospectively included and analyzed consecutive patients undergoing transurethral resection of the prostate at Peking University First Hospital between 1992 and 2013. A multivariate analysis was conducted to evaluate the connection of the ASA and CCI grades with the incidence of complications. RESULTS This paper studied 2326 cases in total. The CCI and ASA grades were significantly correlated, with a Spearman ρ of 0.245 (P <.001). No considerable differences among the patient cohorts with different CCI or ASA grades were observed in terms of day of catheter removal, surgical time, and prostate size. In addition, no considerable differences were observed in the different modified Clavien classification system scores of complications among patient cohorts with different grades of CCI. CONCLUSION The majority of complications (86.9%) were of grades I, II, and III, whereas grade IV was less frequent (12.1%), and, after transurethral resection of the prostate, grade V was rare (1%). Males with an ASA grade ≥3 and higher CCI scores were more likely to demonstrate a higher incidence of morbidity than males with a lower grade. However, ASA grades and CCI scores were not independent predictors of complications because of the experience of the surgeon and progress in perioperative management and operative techniques. Therefore, for patients with more comorbidities and higher CCI scores or ASA grades, active surgical intervention is still suggested.

Squamous Cell Carcinoma of the Enlarged Prostatic Utricle in an Adult

A 39-year-old man with gross terminal hematuria and urethral discharge for 5 months was found to have a partial cystic and partial solid mass above the normal site of prostate, which was confirmed by magnetic resonance imaging (MRI) and transrectal ultrasonagraphy. A radical resection of the tumor was performed, and classical squamous cell carcinoma was confirmed by pathologic assay.

Suprapubic cystostomy versus nonsuprapubic cystostomy during monopolar transurethral resection of prostate: a propensity score-matched analysis

We aim to reassess the safety of the monopolar transurethral resection of the prostate (M-TURP) without suprapubic cystostomy at our institution over the past decade. This retrospective study was conducted in patients who underwent M-TURP at Peking University First Hospital between 2003 and 2013. A total of 1680 patients who had undergone M-TURP were identified, including 539 patients in the noncystostomy group and 1141 patients in the cystostomy group. After propensity score matching, the number of patients in each group was 456. Smaller reductions in hemoglobin and hematocrit (10.9 g vs 17.6 g and 3.6% vs 4.7%, respectively) were found in the noncystostomy group. In addition, patients undergoing surgery without cystostomy had their catheters removed earlier (4.6 days vs 5.2 days), required shorter postoperative stays in the hospital (5.1 days vs 6.0 days), and were at lower risk of operative complications (5.7% vs 9.2%), especially bleeding requiring blood transfusion (2.9% vs 6.1%). Similar findings were observed in cohorts of prostates of 30-80 ml and prostates >80 ml. Furthermore, among patients with a resection weight >42.5 g or surgical time >90 min, or even propensity-matched patients based on surgical time, those with cystostomy seemed to be at a higher risk of operative complications. These results suggest that M-TURP without suprapubic cystostomy is a safe and effective method, even among patients with larger prostates, heavier estimated resection weights, and longer surgical times.

Expression of programmed death ligand-1 on bladder tissues is detected in a clinically and histologically well-defined interstitial cystitis cohort

To investigate the expression of programmed death ligand‐1 (PD‐L1) in interstitial cystitis (IC).

Urodynamic characteristics of pelvic lipomatosis with glandular cystitis patients correlate with morphologic alterations of the urinary system and disease severity.

To explore urodynamic characteristics and their clinical value in pelvic lipomatosis (PL) patients.

Correlation of benign prostatic obstruction-related complications with clinical outcomes in patients after transurethral resection of the prostate

We aim to investigate the correlation of benign prostatic obstruction (BPO)‐related complications with clinical outcomes in patients after transurethral resection of the prostate in China. We reviewed the medical history of all patients who underwent surgery from 1992 to 2013. We assessed the preoperative clinical profile, clinical management, and operative complications. Overall, 2271 patients were enrolled in the study. Of these patients, 1193 (52.5%) had no BPO‐related complications and 1078 (46.3%) had BPO‐related complications. Compared with patients without BPO‐related complications, those with BPO‐related complications were older (p = 0.001) and usually had other urologic comorbidities (p = 0.003). Additionally, they tended to have more tissue resected (p < 0.001), a higher American Society of Anesthesiologists grade (p = 0.002), and larger prostates (p < 0.001). Nonetheless, there was no obvious difference in surgical complications between both groups (p > 0.05). Among patients with BPO‐related complications, compared with the bladder stone group, only the bladder stone+ group tended to have a greater urinary infection risk after transurethral resection of the prostate. Compared with patients with one or two BPO‐related complications, those with three BPO‐related complications tended to have a higher risk of pulmonary embolism and acute coronary syndrome (p < 0.05). Despite the widespread use of medication, patients with BPO‐related complications were older and had larger prostates; however, transurethral resection of the prostate is still considered a safe and recommended surgical treatment. Nevertheless, those with three or more complications were at a higher risk of severe complication after surgery, and active surgical intervention is needed once BPO‐related complications develop.

A nomogram predicting re-operation due to secondary hemorrhage after monopolar transurethral resection of prostate

We aim to develop a nomogram to predict re‐operation due to secondary hemorrhage after Monopolar transurethral resection of the prostate (M‐TURP). We identified patients undergoing M‐TURP at Peking University First Hospital from 2000 to 2013. Univariate and multivariate logistic regression models were developed to predict the occurrence re‐operation due to secondary hemorrhage. The discriminatory ability of the nomogram was tested using the area under the receiver operating characteristic curve (ROC), and internal validation was performed via bootstrap resampling. Of the 1901 patients who underwent M‐TURP during the study period, 9.1% (173 patients) experienced hemorrhage after M‐TURP, and they had a 22.0% re‐operation rate (38 patients). Benign prostatic hyperplasia (BPH)‐related complications (odds ratio, 0.386; 95% CI, 0.177–0.841), percent of resected prostate (OR, 0.156; 95% CI, 0.023–1.060) and suprapubic cystostomy (OR, 0.298; 95% CI, 0.101–0.881) were independently associated with re‐operation. The nomogram accurately predicted re‐operation (area under the ROC curve 0.718). The negative predictive value was 88.0%, while the positive predictive value was 47.9%. Re‐operation due to secondary hemorrhage after M‐TURP was associated with no BPH‐related complications, lower percent of resected prostate and no suprapubic cystostomy and was accurately predicted with using the nomogram.

Repair of complex vesicovaginal fistulas by combining a rotational bladder flap and full thick vascular peritoneal interposition

To present the experience of repairing iatrogenic vesicovaginal fistulas (VVFs) using a rotational bladder flap and peritoneal interposition technique.