To evaluate the tumor control effect of robotic-assisted single port extraperitoneal radical prostatectomy (RA-SPERP) in high-risk prostate cancer patients, and explore the risk factors affecting the tumor control effect of RA-SPERP.

A total of 94 high-risk prostate cancer patients who underwent RA-SPERP in Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2020 to July 2023 were retrospectively included. The median age and PSA of the patients were 70 years and 49.8 ng/ml, respectively. All patients were high risk prostate cancer (PSA>20 µg/lor Gleason score >7 or cT ≥2c), of which 44 were locally advanced tumors (any PSA, any Gleason score; cT₃-T₄ or cN+). After establishing an extraperitoneal channel, place the Lagiport and connect to the da Vinci Si system. The tumor control effect of RA-SPERP was evaluated by the rate of positive surgical margins on pathology and whether PSA persistent at 6 weeks after surgery. Logistic regression analysis was used to analyze the factors affecting tumor control.

All patients successfully completed RA-SPERP without any conversion to laparoscopic or open surgery. Pathology reports showed positive margins in 11 cases(11.70%) and lymph node metastasis in 22 cases (23.40%). A total of 14 cases (14.89%) underwent follow-up examination at 6 weeks post-surgery with PSA ≥0.2 ng/ml. The results of Logistic regression indicate that positive surgical margin event is related to the level of preoperative T staging, with an OR of 2.450. For the event PSA persistent at 6 weeks after surgery, which is related to the initial diagnosis of PSA, International Society of Urological Pathology (ISUP) grade of prostate biopsy, clinical T staging, and lymph node metastasis, with OR values all >1. The nomogram for judging PSA persistent was established based on these four factors.

RA-SPERP is safe and feasible for high-risk prostate cancer patients, and the tumor control effect of surgery is reliable. Preoperative assessment of individual tumor location and tumor burden is the key to reducing the rate of positive surgical margins and avoiding the PSA persistent after surgery.

To explore the safety and effectiveness of magnetic resonance imaging and transrectal ultrasound image (mpMRI-TRUS) fusion transperineal biopsy technique under local anesthesia for suspected prostate cancer patients with ASA grade Ⅲ or higher.

The clinical and pathological data of 151 patients who underwent mpMRI-TRUS image fusion targeted transperineal biopsy using electromagnetic needle tracking under local anaesthesia in Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University) from January 2023 to November 2023 were analyzed retrospectively. According to the preoperative ASA grade, patients were divided into the observation group (ASA grade ≥Ⅲ) and the control group (ASA grade <Ⅲ). Visual analogue scale (VAS) and visual numeric scale (VNS) were used to evaluate the pain and anesthesia satisfaction of patients with prostate biopsy. The pain and satisfaction scores during prostate biopsy (VAS-1 and VNS-1) and 1 hour after biopsy (VAS-2 and VNS-2), the incidence of perioperative complications and the positive detection rate of tumor were compared between the two groups.

There were 151 patients in this study, including 45 patients in the observation group and 106 patients in the control group. The age of patients in the observation group [(72±8) years] was significantly higher than that in the control group [(67±8) years], (P=0.001). The prostate volume [43(21, 167) vs 47(15, 186) cm³], PSA [18.8(3.3, 550.2) vs 17.6(2.1, 457.8) ng/ml], surgical time[(15±4) vs (16±3) min], VAS-1 [(1.8±0.7) vs (1.7±0.7) scores] and VNS-1[(2.78±0.52) vs (2.79±0.45) scores] during prostate biopsy, VAS-2 [(1.1±0.6) vs (1.1±0.5) scores] and VNS-2[(3.7±0.5) vs (3.7±0.4) scores] at 1 hour after biopsy were not significantly different between the observation group and control group (P>0.05). The PI-RADS scores of 2, 3, 4 and 5 in the observation group were 9, 11, 8 and 17 respectively, while those in the control group were 19, 28, 21 and 38 respectively, without significant difference (P>0.05). There was no significant difference between the observation group and the control group in terms of complication hematuria [19.75%(9/45) vs 20.75%(22/106)], urinary retention [4.65%(2/43) vs 4.95%(5/101)] and tumor positive detection rate [60.00%(27/45) vs 62.26%(66/106)] (P>0.05).

For suspected prostate cancer patients with ASA grade Ⅲ or higher, multi-mode image fusion targeted transperineal biopsy technique under local anaesthesia is safe and feasible.

To evaluate the safety and efficacy of 1 470 nm laser tri-lobe resection in the treatment of high-risk benign prostatic hyperplasia (BPH) with reduced volume excision.

The clinical data of 113 patients with high-risk BPH treated by the 1 470 nm laser tri-lobe resection, that is, the mass resection of the middle and bilateral hyperplasia glands of the prostate, were reviewed and analyzed from April 2019 to October 2022. The patient's general condition, operation duration, indwelling catheterization time, etc. were analyzed, and the preoperative and postoperative IPSS score, residual urine output (RUV), urine flow rate (Q_max) and other indicators were compared.

All patients were completed the operation successfully. There was no intraoperative or postoperative blood transfusion. Operation time, decreased value of hemoglobin, bladder irrigation time, indwelling catheter time and hospitalization time were (41.6±15.3) min, (1.1±0.8) g/L, (1.3±0.2) d, (1.7±0.3) d and (5.5±1.2) d respectively. The postoperative IPSS score, QOL score, RUV and Q_max score of 109 cases were significantly better than those before operation (P<0.05). The improvement of urination was not obvious in 4 cases, whose prostate volume were <40 ml.

1 470 nm laser tri-lobe resection has the advantages of minimal trauma, less bleeding, rapid recovery, good efficacy and other advantages. It's suitable for elderly high-risk BPH patients with large prostate volume.

To compare the differences in the protection of postoperative ejaculatory function between transurethral plasma kinetic prostatectomy with preservation of 1 cm the tissue in front of colliculus seminalis (ejaculation-preserving technique) and the tissue between the lobular sulci (Cheng's ejaculation-preserving technique), the anatomical position of Cheng's ejaculation-preserving technique was made.

A retrospective analysis was performed on 27 patients with benign prostatic hyperplasia (BPH), aged (63±5) years, who had sexual activity and normal ejaculatory function and were admitted to the Second People's Hospital of Futian District from April 2021 to March 2023. BPH was treated by transurethral plasma kinetic prostate enucleation (Ep group) with ejaculation-preserving technique and transurethral plasma kinetic prostate enucleation (Cheng's group) with Cheng's ejaculation-preserving technique successfully by the same operator, including 14 cases in Ep group and 13 cases in Cheng's group. Preoperative and postoperative follow-up indexes of the two groups of patients were analyzed.

The operations of all 27 patients was successfully completed. The follow-up time was (7.2±1.2) months. There were no significant differences in preoperative general data between the two groups, including age, prostate volume, international index of erectile function-5 (IIEF-5) and ejaculation status questionnaire, international prostate symptom score (IPSS), quality of life (QOL) score, maximum urine flow rate (Q_max) and residual urine volume (RUV) (P>0.05). During follow-up, IPSS, QOL, Q_max, RUV and IIEF-5 scores were not different significantly between the two groups before and after surgery (P>0.05). In Ep group, the anterograde ejaculation rate was 29% within 3 months and 7 months after operation. The incidence of anterograde ejaculation in Cheng's group was 92% within 3 months and 7 months after surgery.

During transurethral enucleation of the prostate, the preservation of the tissue between the lobular sulci of the prostate has a good effect on the protection of anterograde ejaculation function in short-term follow-up.

To investigate the relationship between serum fibrinogen (FIB), D-dimer and alkaline phosphatase (ALP) and bone metastasis of prostate cancer (PCa), so as to provide reference for clinical diagnosis of PCa bone metastasis.

The clinical data of 98 PCa patients from April 2020 to September 2021 were retrospectively collected, including plasma FIB, D-dimer, ALP, pathological Gleason score, cT, lymph node metastasis, distant metastasis, and bone metastasis. The relationship between the above indexes and PCa bone metastasis were analyzed.

Taking bone metastases as the research object, the receiver operator characteristic (ROC) curve results showed that the cut-off point of FIB was 3.34 g/L, the cut-off point of D-dimer was 1.01 mg/L, and the cut-off point of ALP was 154.80 U/L. Taking the cut-off value as the critical value, the patients were divided into high and low FIB group, and high and low FIB group had significant differences in bone metastasis (P<0.05). There were significant differences in cT, lymph node metastasis and bone metastasis between high and low D-dimer groups (P<0.05). There were significant differences in cT, distant metastasis and bone metastasis between the high and low ALP groups (P<0.05). Univariate and multivariate Logistic regression analysis showed that ALP value and Gleason score were significantly associated with bone metastases of PCa.

High ALP and Gleason scores can be used as important indicators for the diagnosis of bone metastasis in PCa, while FIB and D-dimer can not be used as independent factors for the diagnosis of bone metastasis in PCa.

To review the literature and summarize experiences, an integrated medical-nursing-rehabilitation rapid recovery work model for prostate thermal steam ablation surgery was constructed to optimize the perioperative service model and promote cooperation between doctors, nurses and patients, thereby improving the treatment outcomes.

Patients who underwent prostate thermal steam ablation surgery in Urology department of Zhaoqing Hospital, the Third Affiliated Hospital of Sun Yat-sen University from July 2023 to March 2024 were studied. Twenty cases from July to November 2023 served as the control group, receiving routine nursing care, while twenty-five cases from December 2023 to March 2024 were the observation group, receiving the integrated medical-nursing-rehabilitation rapid recovery model. An integrated work checklist was established, divided into four stages: preoperative preparation, the day of surgery, the period of postoperative catheter retention, and after catheter removal. Multidisciplinary, standardized, and structured care was implemented across various aspects including preoperative preparation, surgical treatment, postoperative nursing, health education, rehabilitation therapy, complication prevention, life guidance, and postoperative follow-up. The comparison was made between the theoretical test scores of nurses before and after the implementation of the model and the execution rate of related nursing activities, the comparison was also made between the two groups in terms of the success rate of one-time catheter removal after surgery, overall satisfaction, postoperative complication incidence, and psychological state differences at two weeks postoperatively.

After the implementation, the theoretical test score of nurses (98.85±1.52) in observation group was significantly higher than before (82.15±11.26), with a significant difference (t=-5.300, P<0.001), the execution rate of related nursing activities (100%) after implementation was higher than before (7.7%), with significant difference (P<0.001). The success rate of one-time catheter removal after surgery in the observation group (84%) was higher than that in the control group (75%), but the difference was not statistically significant (χ²=0.141, P=0.708). The overall satisfaction in the observation group was higher than that in the control group (P=0.001). The incidence of postoperative complications (hematuria, urinary retention) in the observation group (28%, 20%) was lower than that in the control group (70%, 50%), with significant difference (χ²=7.875, P=0.005; χ²=4.500, P=0.034). The incidence of other postoperative complications (urinary tract infection, urinary urgency, urinary pain) in the observation group (8%, 12%, 12%) was lower than that in the control group (25%, 25%, 30%), but the difference was not statistically significant (χ²=1.322, P=0.250; χ²=0.549, P=0.459; χ²=1.266, P=0.261). The scores of PHQ-9 and GAD-7 scales at two weeks postoperatively in the observation group [0(0, 1.0), 2.0(0.5, 5.0)] were both lower than those in the control group [6.0(4.3, 12.0), 7.0(4.3, 10.3)], with significant differences (Z=-3.896, P<0.001; Z=-3.018, P=0.003).

The construction and implementation of the integrated medical-nursing-rehabilitation rapid recovery model for prostate thermal steam ablation surgery is conducive to improving the level of relevant theoretical knowledge of nurses and the execution rate of related nursing activities, reducing postoperative complications, promoting the physical and mental recovery of patients, improving overall patient satisfaction, and facilitating the promotion of new technology.

To report the effect of the clinical treatment of the renal angiomyolipoma with inferior vena cava tumor thrombus through Robot-assisted laparoscopic radical nephrectomy, then review the clinical progress in diagnosis and treatment of renal angiomyolipoma with inferior vena cava tumor.

The clinical data of the patients who were treated in the First Affiliated Hospital of AnHui Medical University from March 2021 to October 2021 was analyzed and a summary with relevant literature was made.

One case was a 39 year old male and the other case was a 57 year old female, both patients’ tumors were on the right side. The size of the tumor of the male patient was 15.0 cm×10.0 cm×9.0 cm with Mayo grade Ⅱ inferior vena cava tumor thrombus. The size of the tumor of the other patient was 6.0 cm×4.8 cm×4.5cm with Mayo grade Ⅱ inferior vena cava tumor thrombus. Both of 2 cases underwent robot-assisted laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy. The operation was successful in the group without conversion to laparotomy and no complications occured during the perioperative period. Postoperative pathology proved renal angiomyolipoma with inferior vena cava thrombus. After 12 months and 3 months of follow-up, both of patients did not have relapse and transfer.

The case of renal angiomyolipoma with inferior vena cava tumor thrombus is rare in clinic which is in great need of surgical treatment, and the postoperative prognosis is normally positive. The cases we reported prove the feasibility of robot-assisted laparoscopic radical nephrectomy and inferior vena cava tumor thrombectomy in treating renal angiomyolipoma with Mayo grade Ⅱ inferior vena cava tumor thrombus.

To explore the safety and effectiveness of pre dissection of bladder mucosa around the ureteral opening combined with early bladder infusion chemotherapy during radical nephroureterectomy for upper urinary tract urothelial carcinoma.

The clinical data of 5 patients encountered from January 2021 to August 2023 with carcinoma of renal pelvis or ureteral carcinoma treated in Minhang Hospital Affiliated to Fudan University were reviewed. Before undergoing radical nephrectomy, these patients underwent pre dissection of the bladder mucosa around the ureter opening and bladder infusion chemotherapy by 50 ml physiological saline and 2.0 g gemcitabine. On the 7th day after surgery, before removing the catheter, 50 ml of physiological saline and 2.0 g of gemcitabine were administered for bladder infusion chemotherapy again. All patients underwent blood analysis, blood biochemistry, urine test, urine cytology, and imaging (urinary system ultrasound, CTU or MRU) examinations every 3 months after surgery. If necessary, cystoscopy will be performed to determine the occurrence of tumor recurrence, metastasis, and other conditions.

All patients successfully completed the surgery, with good postoperative recovery and no occurrence of fever, hematuria, urinary leakage, incision infection, or incision hernia. The follow-up time of 5 patients was 6-25 months. Except for one patient with renal pelvis cancer and ureteral cancer who was diagnosed with low-grade malignant potential urothelial tumor of the bladder at the 10th month after surgery, the other four patients did not experience tumor recurrence or metastasis during follow-up.

By using the pre dissection technique of bladder mucosa around the ureteral opening, the complete resection of the distal ureter and ureteral opening is ensured, while improving surgical efficiency and reducing the occurrence of surgical complications. The performance of twice bladder infusion chemotherapy by physiological saline 50 ml+ gemcitabine 2.0 g in early intraoperative and on the 7th day after surgery is well-designed, easy to operate, and has minimal adverse reaction.

To conduct a cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES) database in the United States to analyze the relationship between serum lipids and kidney stones.

7 154 participants were selected from the NHANES database from 2007 to 2016. Univariate and multivariate Logistic regression models and restricted cubic spline plots were used to analyze the correlation between serum lipids (high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, total cholesterol, cholesterol /high-density lipoprotein cholesterol) and the risk of kidney stones.

The relationship between high-density lipoprotein cholesterol and kidney stones was non-linear, and the incidence of kidney stones decreased with the increase of high-density lipoprotein cholesterol. The relationship between low-density lipoprotein cholesterol, triglyceride, total cholesterol and cholesterol /high-density lipoprotein cholesterol and kidney stones were linear, and the risk of kidney stones increased with the increase of low-density lipoprotein cholesterol, triglyceride, total cholesterol and cholesterol/high-density lipoprotein cholesterol.

Low high-density lipoprotein cholesterol, high low-density lipoprotein cholesterol, hypertriglyceridemia, hypercholesterolemia, and high cholesterol/high-density lipoprotein cholesterol are associated with the incidence of kidney stones. The optimal management of dyslipidemia may reduce the risk of kidney stones.

To analyze the effect of holmium laser lithotripsy (HLL) combined with tamsulosin on patients with ureteral calculi.

A total of 120 patients with ureteral calculi admitted to Qinhuangdao Traditional Chinese Medicine Hospital from March 2020 to September 2021 were selected and divided into observation group and control group according to random number table method, with 60 cases in each group. The control group was treated with HLL surgery and postoperative placebo, while the observation group was treated with tamsulosin after surgery. The stone excretion rate, VAS, symptom score of stone, actility of daily living, urinary biochemical indexes, inflammatory factor level and treatment safety were evaluated and compared between the two groups.

The stone removal rates of the observation group at 1 week, 4 weeks and 12 weeks after operation were higher than those of the control group (P<0.05). After treatment, visual analogue scale (VAS) and S.T.O.N.E scores of observation group were lower than those of control group, and activity of daily living (ADL) scores were higher than those of control group (P<0.05). After treatment, the urinary biochemical indexes including uric acid (UA), urinary oxalic acid (UOA) and urinary calcium (U-Ca) in the observation group were lower than those in the control group (P<0.05). After treatment, the inflammatory factors of neutrophil gelatinase-associated lipid carrier protein (NGAL), chemokine 1(CXCL1), oxidized α1-antitrypsin (ox-AAT), white blood cell count (WBC), neutrophil percentage (NEUT%) and hypersensitive C-reactive protein (hs-CRP) in observation group were lower than those in control group (P<0.05). The urea nitrogen (BUN) and creatinine (Cr) in observation group were lower than those in control group (P<0.05). There was no significant difference in the incidence of adverse reactions ketween two groups (P>0.05).

Combined treatment with tamsulosin in patients with ureteral calculi after HLL can improve the stone excretion rate, reduce the VAS score and stone symptom score, improve the quality of life, reduce the level of urinary biochemical indexes and inhibit the expression of inflammatory factors, and is safe.

To compare the safety and efficacy of intelligent pressure-controlled flexible ureteroscopic suctioning lithotripsy (IPFUSL) with retrograde intrarenal surgery (RIRS) in the treatment of upper urinary tract stones with diameter of 10 to 25 mm.

The clinical data of 85 patients with upper urinary tract stones who underwent surgical treatment and completed post-operative follow-up at the Department of Urology, Guangdong Medical University Hospital from June 2021 to August 2022 were recorded. Patients were grouped according to whether they received IPFUSL, 43 patients received IPFUSL as the observation group and 42 patients received conventional RIRS as the control group. Comparison of laboratory indicators before and after surgery, time of surgery, stone removal rate at 1 month after surgery, post-operative hospital stay and complication rate.

All 85 patients successfully completed the operation. There was no statistical significance in preoperative baseline data, postoperative leukocyte rise, hemoglobin decline, creatinine change values and postoperative procalcitonin levels between the two groups (P>0.05). There was no significant difference in stone free rate 1 month after operation between two groups (83.7% vs 73.8%, P>0.05). The postoperative hospitalization stay in the observation group was shorter than the control group [(1.2±0.4) d vs (1.5±0.8) d, P=0.045]. The incidence of surgical complications in the observation group was significantly lower than the control group [4.7% vs 21.4%, P=0.021].

IPFUSL and RIRS are both safe and effective surgical methods for the treatment of upper urinary stones with diameters of 10 to 25 mm. The stone free rate of them is similar, but the former has better safety, and has the advantages of quick postoperative recovery and short hospital stay, which is worthy of promotion in clinical practice.

To construct EGFR-MEK-TZ three combined targeting molecule LN-1 and investigate its effect on castration-resistant prostate cancer cells.

The molecular structure of LN-1 was designed and the steps of molecule synthesis were studied accordingly. Castration-resistant prostate cancer cells PC3 and LNCap were studied, then experimental group and control group were divided, respectively. The experimental group was treated with LN-1. The effects of LN-1 on the proliferative activity of PC3 and LNCap cells were detected by CCK-8 assay, clonal formation assay and EdU fluorescence staining. The expression levels of apoptosis-related genes in castration-resistant prostate cancer cells in each group were detected by RT-qPCR.

The designed LN-1 molecule was composed of three active fragments: EGFR fragment, MEK fragment and alkylation fragment TZ, which were interlinked with each other through diethanolamine fragment. EGFR fragment and MEK fragment were coupled through carbonate amide bond. Using MEK fragment as starting material, the target product LN-1 with 43.3% yield was obtained. LN-1 effectively inhibited the proliferative activity of PC3 and LNCap cells (P<0.05). In addition, mRNA levels of Caspase-3, p53 and Bax in the experimental group were significantly higher than those in the control group, with significant difference (P<0.05).

The successful construction of EGFR-MEK-TZ three combined target molecule LN-1 suggests the rationality and feasibility of this molecular structure design, which can play an antitumor role by inhibiting proliferation and inducing apoptosis of castration-resistant prostate cancer cells PC3 and LNCap.