| Part 1:The pathological analysis on prostatic capsule Objective:To study the pathological structure of the prostatic capsule and the consistency of the two surgical methods was evaluated.Methods:30 prostatic capsule samples were collected from SOP(n=10)?retropubic open prostatectomy(ROP,n=l 0),and the laparoscopic radical prostatectomy(LRP,n=10)from January 2009 to February 2016,which were stained with HE?Van Giesons and Masons,prostatic capsule structure and arrangement structure were analysised.Results:Histological studies suggested that the three groups of prostatic capsule was composed of smooth muscle and collagen fibers.The smooth muscle layer formed a inner longitudinal and outer annular layer structure,in which the ratio of annular and longitudinal smooth muscle layer was 1:2 or 2:3,and the longitudinal layer was more extensive,there was no significant difference in smooth muscle ratio between the three groups.(P>0:05).Conclusions:Longitudinal smooth muscle layer of the prostatic capsule may be the anatomical basis of prostatectomy.Prostatectomy can effectively repair the prosthetic tissue by following these pathological structures.It may reduce the incidence of surgical-related side injuries.Part 2:The pathological analysis of TUERP related prostate surgical capsuleObjective:To compare the pathological features of prostate surgical capsule between transurethral plasmakinetic resection of the prostate(TUERP)and suprapubic open prostatectomy(SOP).Methods:40 cases TUERP and 40 cases SOP specimens were collected from January 2008 to February 2016,TUERP specimens 1-3were collected by transurethral endoscopy after TUERP.They were deep tissue of prostate resected by transurethra,tissue adjacent to prostate surgical capsule on the surface of prostate resected by transurethra and tissue of prostate fossa after TUERP.40 cases of SOP specimens were got by combined SOP with TURP,and the content and order were same with TUERP group.HE staining was used to analyze the pathological components.In addition to the two groups of enucleation of prostate tissue were weighed and the enucleation rate was compared between the two groups.Results:The pathological features of prostate surgical capsule for both group were roughly same,sample 1 were gland mostly,less were smooth muscle and fibrous tissue components;sample 2 were fibrous tissue and smooth muscle component mostly and a small amount of glandular components,and more close to the surgical capsule,more fibrous tissue,less glandular components;sample 3 mainly were fibrous tissue and inflammatory cells and almost no glandular components.There was a statistically significant difference between the two groups in the specimens 1-3(P<0.05);there was no significant difference between the two groups(P>0.05).Enucleation rate for TUERP and SOP were same roughly?about 58.2%,and there was no significant difference(P>0.05).Conclusion:The prostate surgical capsule was mainly composed of smooth muscle and fibrous tissue,the prostate surgical capsule in TUERP was similar to SOP,and TUERP can effectively remove gland tissue with in the safe range.Part 3:Analysis on NVB around prostatic capsule Objective:To conduct an MRI analysis of NVB surrounding prostatic capsule in normal prostate,BPH,and PCA.Moreover,to assess the value of 3.0T MRI in diagnosing NVB invasion.Methods:We retrospectively collected data from January 2011 to January 2017,prostate MRI images for 10,20,and 42 cases of normal prostate,BPH,and PCA were comparatively investigated regarding the course and distribution of NVB surrounding prostatic capsule and NVB invasion.Moreover,consistency between NVB invasion images by MRI and postoperative PCA pathology was compared.ResuIts:NVB distribution along prostatic capsule showed no statistical difference for normal prostate,BPH,and PCA(P>0.05).NVB distribution surrounding capsule at center of prostate showed greatest density.NVB located in dorsolateral(about 60%),diffuse in ventralateral region(about 40%).Additionally,images of PCA's NVB invasion were varied by fat gap loss between NVB and prostatic capsule.Of 42 PCA cases,20 diagnosed as NVB invasion by preoperative MRI,while 16 received pathological diagnosis of NVB invasion,MRI sensitivity was 75%with 95.45%specificity,the positive and negative predictive values were 93.75%and 80.77%.,MRI diagnosis was approximately corresponded with pathological result,P<0.05?Conclusions:No statistically significant disparities were observed to the variable of NVB distribution along prostatic capsule for normal prostate,BPH,and PCA.3.0T MRI is effective displaying a clear image of NVB invading as fundamental reference to determine the NVB preservation for patient,and is valuable for tailored decision-making prior to radical prostatectomy.Part 4:Application value of preoperative MRI in the distribution of NVB around prostatic capsule in nerve-sparing laproscopic radical prostatectomyObjective:To investigate the difference of the distribution of neurovascular bundles(NVB)around the prostatic capsule detected by preoperative magnetic resonance imaging(MRI)and its clinical value in nerve-sparing radical prostatectomy(NS-LRP)..Methods:The clinical data of 42 patients with clinically localized prostate cancer who were admitted from January 2008 to January 2017 were retrospectively analyzed.Age range from 58 to 74 years,with an average of 68 years.Preoperative serum PSA range from 0.94 to 12.28 ng/dl,with an average of 7.01 ng/dl.Preoperative Gleason score range from 5 to 10,with an average of 6.Clinical stage:TI-T2 phase 37 cases,T3 phase 5 cases.The preoperative International Erectile Function Index questionnaire-5(IIEF-5)averaged 21,of which 23 cases had normal erectile function(IIEF-5>22).All the 42 patients underwent MRI examination before operation.According to the distribution of NVB around the prostatic capsule,they were divided into 3 groups:17 cases in group A,and no NVB was evident in all cases.In group B,8 cases were visible but not obvious.In group C,17 cases were evident NVB.There was no significant difference in age,preoperative serum PSA and Gleason score between the three groups(P>0.05).The preoperative IIEF-5 in group A,B,and C were 19.5,22.8,and 21.5,respectively,with no statistically significant difference(P>0.05).All 42 cases were received NS-LRP under general anesthesia.The differences in IIEF-5 before and after surgery were compared between the three groups.Results:In this study,42 cases were successfully completed.42 patients were followed up for 12 to 36 months,with an average of 14.1 months.In group A,B,and C,postoperative IIEF-5 was 8.0,14.1,and 15.5,respectively,which was statistically significant compared with preoperative values(P<0.05).The decrease of IIEF-5 after operation in group A was significantly different from that of group B and C(P<0.05).Conclusion:Compared with patients with visible NVB on MRI examination,patients have no visible NVB observed on MRI with erectile function-related nerves around the prostatic capsule may be walking on both sides of the prostatic capsule and spreading over the entire anterior ventral surface of the prostate.To preserve NVB and postoperative erectile function to the utmost,NS-LRP surgery should be more accurately dissected and dissociated on both sides and ventral side of the prostatic capsule. |
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