| Objectives:1. To evaluate the change of prostatic elasticity during the development of BPHand its correlation with the degree of BOO in the canine model; And to explore thehistopathological basis of the change of prostatic elasticity during the development ofBPH.2. To investigate the changes of Young modulus of transitional and peripheral zoneof prostate between normal human and BPH patients; And to evaluate the correlationbetween Young modulus of transitional zone of prostate and the severity of BOO inBPH patients.Methods:1. Animal experiment(1) Ten male beagle dogs were selected in this study. To establish canine model ofBOO caused by BPH, each beagle underwent castration surgery followed byencapsulating the prostate with a double layer of nylon mesh and then treating with acombination of steroids for3months. Transrectal ultrasound examination andurodynamic evaluation were performed before and at1,2and3month of hormoneadministration. Prostatic volume, Young modulus of prostate tissue and urodynamicparameters were compared at each time instance, and the correlation between the Youngmodulus of the prostate tissue and urodynamic parameters were evaluated.(2) Twenty-four male beagle dogs were divided into four groups, six each group.Each beagle underwent castration surgery followed with a combination of steroids for3months. Transrectal ultrasound examination was performed before and at1,2and3month of hormone administration. One group of animals was killed after theexamination and took the prostatic tissue. The pathological section was stained with HE,masson, reticular fiber and smooth muscle immunohistochemistry. The change of various pathological components was observed at each time instance, and thecorrelation between the prostatic elasticity and pathological components were evaluated.2. Clinical experiment(1) A total of221healthy volunteers and BPH patients were involved in this study,which received TRUS and SWE to obtain prostate weight, Young modulus oftransitional zone and peripheral zone of prostate. Young modulus of transitional zoneand peripheral zone of prostate were compared in different age and prostatic weightgroups，and their correlation with age and prostatic weight were evaluated.(2) A total of52patients were enrolled in this study. IPSS, QOL assessment weredone firstly, and then TRUS and SWE were performed to obtain TPV, TZV, TZI andYoung modulus of transitional zone and peripheral zone of prostate. Urinary dynamicexamination was performed for diagnosing BOO as the golden standard. Compare thedifferences of each parameter in different BOO grade groups, and evaluate itscorrelation with the degree of BOO. Receiver-operating characteristic (ROC) curve wasused to assess the diagnostic value of different non-invasive features.Result:1. Animal experiment(1) All beagles developed BOO caused by BPH over the time. Prostatic volume,Young modulus of prostatic tissue had significant statistical differences before and afterhormone administration (P <0.01). There was no significant change of urodynamicparameters before and after the surgery (P>0.05). The urodynamic parameters hadsignificant differences before and after hormone administration (P <0.01).Youngmodulus of prostatic tissue showed a very significant correlation with urodynamicparameters, among them Qmax (r=-0.802, P <0.01) and Pdet@Qmax (r=0.757, P <0.01)had a higher correlation（r=0.958, P <0.01）.(2) Prostatic volume, Young modulus of prostatic tissue had significant statisticaldifferences before and after hormone administration (P <0.01). The height of epithelialand the area of glandular lumen increased gradually during the development of BPH,which had significant statistical differences (P <0.01). The area ratio of glands， glands/interstitial increased gradually, and the area ratio of interstitial, collagen fibers,reticular fibers and smooth muscle decreased gradually, which all had had statisticalsignificant differences at each instance(P <0.01). The content of various elements allincreased after the hormone administration(P <0.01), and showed a very significantcorrelation with the Young modulus of prostatic tissue, among them the content ofglands had a higher correlation（r=0.958, P <0.01）.2. Clinical experiment(1) Young modulus of transitional zone and peripheral zone of prostate hadsignificant statistical differences in different age and prostatic weight groups (P<0.01).Except the young group (P>0.05), Young modulus of transitional zone of prostate washigh than that of peripheral zone in different groups (P<0.05). And Young modulus oftransitional zone of prostate showed a significant correlation with age (rage=0.715,P<0.01) and degree of hyperplasia (rweight=0.673, P<0.01).(2) TPV, TZV, TZI, IPSS and Young modulus of transitional zone of prostate hadsignificant differences in different BOO groups (P<0.05), and showed a significantcorrelation with BOO stages. Among them, Young modulus of transitional zone hadhigher correlation coefficient with BOO stages (r=0.717, P<0.01) than the other features.It also had the highest area under curve of0.813(95%CI0.697～0.928) for BOO. Aselastic modulus of the transitional zone≥32.41kPa was diagnostic of BOO, thesensitivity and specificity for diagnosing BOO was65.0%and91.7%.Conclusion:1. Young modulus of prostatic tissue increased during the development of the BPH.And there was a significant correlation between Young modulus of prostatic tissue andthe degree of BOO. The increase of Young modulus of prostatic tissue had a highercorrelation with the content of gland.2. Young modulus of transitional zone of prostate increased with the age anddevelopment of the BPH. And there was a significant correlation between Youngmodulus of transitional zone of prostate with age and the degree of hyperplasia.Youngmodulus of transitional zone of prostate had highly correlated with the severity of BOO, which might serve as a novel, promising indicator to assess BOO in BPH patients... |
PDF Full Text Request