On November 3, the 2020 National Science and Technology Awards Conference was held in the Great Hall of the People in Beijing, and the project "New Theory and Precision Surgical Intervention System for Prostate Wound Repair" led by the expert team of the Urology Clinical Medical Center of Shanghai First People's Hospital won the second prize of the National Science and Technology Progress Award, and Professor Xia Shujie, the discipline leader of the Urology Clinical Medical Center of the First Municipal Hospital, accepted the award in Beijing as the first completer of the project.
Prostatic hyperplasia is a common disease that seriously affects the health of middle-aged and elderly men, and about 6 million patients in China need to undergo surgical treatment. If the operation is not timely, it will lead to urinary retention, bladder stones, repeated bleeding of the prostate, and even cause serious complications such as hydronephrosis and uremia, which is life-threatening. However, postoperative recurrence is easy, easy to lead to urinary incontinence and erectile dysfunction, many complications, long recovery time, advanced age and high risk of surgery in patients with large prostate and other issues have always been like several mountains in front of the patient, making them dilemmas and difficult to choose.
To this end, the team of Urology Clinical Medical Center of Shanghai First People's Hospital lasted for 20 years, jointly with Zhujiang Hospital of Southern Medical University and Guizhou Provincial People's Hospital, to accurately target the problems that need to be solved urgently in prostatic hyperplasia surgery, innovate and carry out a series of pioneering studies, systematically establish a precision surgical intervention system for prostatic hyperplasia, and significantly improve the efficacy and diagnosis and treatment level of prostatic hyperplasia surgery in China. The innovative series of research results have been written into the European guidelines and the classic textbooks of urology in the United States, "Campbellwash Urology", "Smith Urology", and the domestic masterpieces "Wu Jieping Urology" and "Guo Yinglu Andrology".
Conventional wisdom holds that repair of prostatectomy wounds is done by crawling over the adjacent bladder mucosa and urethral epithelium. The team of Urology Clinical Medical Center of Shanghai First People's Hospital confirmed that in fact, the stem cells of prostate wounds are transdifferentiated into urothelial cells under the stimulation of urine and participate in wound repair, thus subversively proposing a new theory of prostate surgical wound repair, which lays a solid theoretical foundation for effective prevention of complications and helping patients recover faster and better after surgery. In view of the establishment of a new theory of prostate wound repair, the team targeted the "seed" theory of wound protection, that is, during prostatic hyperplasia surgery, as far as possible to protect prostate wound cell activity and avoid excessive thermal damage.
To this end, the team further studied surgical methods and surgical instruments to reduce wound heat damage, and pioneered the first transurethral thulium laser peeling orange prostatectomy (tmlrp-tt) in the world. The depth of thermal damage to the wound surface of traditional minimally invasive surgery is about 5 mm, while the thickness of the prostate envelope is only 2 mm, and thermal injury is the direct cause of the high incidence of complications after traditional minimally invasive surgery. The depth of thermal damage of thulium laser is only 0.2mm, which combines the characteristics of shallow thermal damage and good hemostasis of thulium laser with prostate anatomy, which is close to "zero bleeding" during surgery, which can accurately protect the urethral sphincter and erectile nerve.
The team also innovated the key technique of minimally invasive prostate anatomical removal. It solves the problems of large trauma and large residue and easy recurrence of turp tissue in open surgery, and can completely remove proliferative tissue. At the same time, a new surgical planer is innovatively developed to push the overall removed tissue into the bladder, and then crush it and remove it through the urethra, which significantly improves the efficiency of surgery.
Due to the high price of imported thulium laser machines, it is difficult to promote. Under the support of the National Science and Technology Support Program, the team actively carries out the co-construction of medical enterprises and the transformation of clinical research achievements, and independently develops the domestically produced thulium laser prostatic hyperplasia surgical treatment system - srm-t125 dual-working mode thulium laser treatment machine. Successfully optimized the thulium laser wavelength from 2.0μm to 1.94μm, further reduced the depth of thermal damage to 0.1mm, realized the localization of equipment at the same time, but also carried out appropriate technology regional network promotion and radiation application to the whole country, has been promoted to county-level hospitals, so that the majority of grass-roots patients benefit.
From new theoretical breakthroughs, to new technology revolutions, to new equipment research and development, the team has been striving for excellence and pursuing the ultimate for twenty years, and finally systematically established a precision surgical intervention system for prostatic hyperplasia. The establishment of this system broke many records for prostatic hyperplasia surgery. Surgery is faster and safer, with a 32% reduction in surgery time and almost "zero bleeding", allowing advanced and at-risk patients to have access to safe surgery opportunities. At the same time, it also breaks the "forbidden area" that the large-volume prostate cannot accept traditional minimally invasive surgery.
The postoperative recurrence rate decreased from 6% to 18% to 0.5%-1%, the incidence of postoperative urinary incontinence decreased from 16% to 1.5%, and the incidence of postoperative erectile dysfunction decreased by 45.2% compared with traditional minimally invasive surgery. At present, the team has completed 8275 cases of surgery under the "Precision Surgical Intervention System for Prostatic Hyperplasia", and the technical system has been extended to 688 hospitals at home and abroad, with a total of 61700 treatment cases.
Author: Hu Yang Li Chenyan
Editor: Li Chenyan