To explore the possibility of partial nephrectomy in the treatment of renal cancer with renal vein tumor thrombus.

From January 2018 to December 2021, laparoscopic partial nephrectomy was carried out in Shanghai Changhai Hospital for renal malignant tumors. Six of these patients had renal cell carcinoma with renal vein tumor thrombus. Four were males and 2 were females. Three tumors located in the left kidney and 3 in the right kidney.

The tumor was 1.8-3.5 cm in diameter. Five patients were successful in sparing the kidney. In one case, the renal vein was full of thrombus and the distance from the tumor to thrombus was far away. Therefore, the surgery was converted to radical nephrectomy. In one patient with solitary kidney, iced water was applied during surgery. The operation time was 129-195 min, the warm ischemia time was 24-32 min, and the intraoperative bleeding volume was 100-200 ml. No positive margin was detected in the patients with successfully kidney sparing. One patient had mild hematuria after operation, and it was improved by continuous bladder irragation. Renal clear cell carcinoma was diagnosed in all patients, and no recurrence occured after 18 to 51 months of follow-up.

Laparoscopic partial nephrectomy may be a new alternative treatment for highly selective patients with renal cell carcinoma and renal vein tumor thrombus. However, due to the limited data at present, the safety and effectiveness of laparoscopic partial nephrectomy can not be evaluated accurately. Radical nephrectomy is still the standard treatment for such patients.

To investigate the prognostic value of a combination of systemic immune-inflammatory index (SII) and prognostic nutrition index (PNI) in patients with renal cell carcinoma (RCC) undergoing laparoscopic nephrectomy.

The clinical data of 633 cases with RCC undergoing laparoscopic nephrectomy in the First Hospital of Shanxi Medical University from January 2013 to December 2021 were retrospectively analyzed. SII and PNI were calculated based on peripheral blood cell count and serum albumin, the optimal cut-off values were determined using X-tile software, and SII-PNI scores were constructed. All patients were divided into three groups according to SII-PNI scores, and the correlation of clinicopathological features between the groups was analyzed. Kaplan-Meier curve was used to analyze the effects of SII-PNI score on overall survival (OS) and recurrence-free survival (RFS) of patients with RCC. Univariate and multivariate Cox regression analysis was used to determine prognostic factors. Receiver operating characteristic (ROC) curve was used to evaluate the prognostic efficacy of each indicator.

A total of 633 patients were enrolled. The results showed that SII-PNI score was significantly correlated with age, smoking history, diabetes history, pT stage, Fuhrman grade, surgical method and tumor size (all P< 0.05). The 3-year OS of patients with SII-PNI scores of 0, 1, and 2 was 97.0%, 89.5%, and 57.1%, and the 3-year RFS was 95.1%, 90.8%, and 78.6%, respectively. Kaplan-Meier curve showed patients with low SII-PNI score had significantly better OS and RFS than those with high SII-PNI score (P<0.001). Univariate and multivariate Cox analysis further showed that SII-PNI score was an independent prognostic indicator of OS (P<0.001) and RFS (P<0.001), and was more predictive than SII and PNI alone.

Preoperative SII-PNI score can be used as an independent prognostic indicator for patients with RCC after laparoscopic nephrectomy.

To investigate the feasibility of applying indocyanine green fluorescence imaging technique to preserve thelymphatic vessels of the spermatic cordduring laparoscopic Palomo.

The clinical data of 51 patients in Guangzhou Women and Children Medical Center with primary varicocele were analyzed from June 2020 to December 2021. They were randomly divided into 2 groups. Twenty-five cases in the research group underwent ICG-aided laparoscopic Palomo to preserve lymphatic vessels. 1ml of indocyanine green solution (2.5 mg/ml) was injected into the testis of the affected side during the operation, the lymphatic vessels of the spermatic cord were identified and preserved under laparoscopy. Twenty-six cases in the control group received traditional laparoscopic Palomo. The common data, operation time, intraoperative blood loss and postoperative recovery were compared.

All the operations were successfully completed without conversion to open surgery. The lymphatic vessels of the spermatic cord were successfully identified in the research group, with 2-3 lymphatic vessels preserved and a median development time of 20 s (15-30 s). The operation time had no significant difference between the two groups. The rate of postoperative hydrocele testis in control group was higher than that of the research group (P=0.041). The relapse and testicular atrophy had no significant difference between the two groups. The postoperative bilateral testicular volume of the two groups increased significantly (P<0.001).

The application of indocyanine green fluorescence imaging technique for preserving the lymphatic vessels of the spermatic cord during laparoscopic Palomo is safe and effective, and allows for rapid and accurate identification of the lymphatic vessels, avoiding postoperative complications such as hydrocele testis.

To evaluate the safety and effectiveness of superselective prostatic artery embolization (PAE) for treating benign prostatic hyperplasia (BPH) with acute urinary retention (AUR) in high-risk elderly patients.

A retrospective analysis was conducted on 35 cases of BPH patients with AUR treated at Nanjing Drum Tower Hospital from August 2018 to October 2021. The patients' age ranged from 70 to 88 years (mean age 78±5 years), and all patients had one or more significant comorbidities involving vital organs such as the heart, brain, and lungs. Using digital subtraction angiography and C-arm cone-beam CT dual localization, super-selective prostate artery embolization was performed. The clinical evaluation criterion was the absence of AUR within 1 year after the removal of the urinary catheter. Additionally, comparisons were made for prostate volume, maximum urinary flow rate (Q_max), international prostate symptom score (IPSS), quality of life score (QOL), undisturbed sleep time (HUS), and national institutes of health chronic prostatitis symptom index (NIH-CPSI) at 1, 3, 6, and 12 months postoperatively.

The surgeries were successful for all 35 patients, and there were no serious adverse reactions postoperatively. Urinary catheters were removed one week after surgery, with 30 cases recovering spontaneous urination, while 5 cases experienced recurrent urinary retention and continued catheterization. In these 5 cases, self-urination was reestablished after catheter removal within 1 to 2 weeks. None of the patients experienced AUR again within one month to the first year postoperatively. Compared to the preoperative status, there was a significant reduction in prostate volume and nocturia frequency after surgery, symptoms such as IPSS, QOL, HUS, and NIH-CPSI showed significant enhancement (P<0.001). Compared to one month after surgery, Q_max gradually increased over time (P<0.001).

The utilization of PAE in the management of BPH accompanied by AUR is both safe and efficacious. Therefore, PAE can be considered as a viable therapeutic option for elderly or high-risk BPH patients.

To explore the value of preoperative fibrinogen to albumin ratio (FAR) in predicting postoperative recurrence in NMIBC patients after transurethral resection of bladder tumor (TURBT), and to construct a nomogram model for predicting postoperative recurrence in NMIBC patients based on FAR.

Clinical data from 162 NMIBC patients treated at Zhongshan City People's Hospital Affiliated to Guangdong Medical University from September 2016 to December 2021 was retrospectively analyzed. Cox regression model was used to screen for independent risk factors for postoperative recurrence in NMIBC patients and a nomogram model was constructed.

The no recurrence survival rate of patients in the preoperative low FAR group was better than that in the preoperative high FAR group (P<0.05), and there was a statistically significant difference in tumor number and pathological grading between the two groups (P<0.05). Preoperative high FAR, number of tumors ≥8, clinical T₁ stage, and high pathological grade are independent risk factors for recurrence in patients (P<0.05). The nomogram model constructed from the above four factors predicts the ROC area under the curve for 1 year, 3 year, and 5 year recurrence free survival in NMIBC patients after TURBT, with ROC values of 0.87 (95%CI:0.81-0.94), 0.80 (95%CI:0.70-0.89), and 0.73 (95%CI:0.56-0.89), respectively. At 1 year, 3 years, and 5 years after surgery, the overall clinical benefits of the nomogram model (clinical T stage+pathological grade+number of tumors+FAR) were higher than those of the non FAR factor model (clinical T stage+pathological grade+number of tumors).

Preoperative high FAR is an independent risk factor for postoperative recurrence in NMIBC patients undergoing TURBT. The nomogram model constructed based on FAR can provide theoretical basis for the subsequent treatment of NMIBC patients undergoing TURBT and the formulation of personalized follow-up plans, guiding clinical practice to a certain extent.

Explore the application effect of enhanced recovery after surgery in robot assisted laparoscopic cystectomy and ileostomy.

110 patients who underwent robot assisted laparoscopic cystectomy and ileostomy in Drum Tower Hospital Affiliated to Nanjing University School of Medicine from February 2020 to February 2022 were randomly divided into two groups, with 55 patients in each group. The control group received routine intervention, while the observation group received enhanced recovery of surgical intervention. The adaptation level of stoma, quality of life before and after surgery, and incidence of stoma complications between the two groups were compared at 6 months after surgery.

The postoperative recovery time of the observation group was better than that of the control group (P<0.05). The observation group had a higher level of stoma adaptation and quality of life 6 months after surgery compared to the control group (P<0.05); The incidence of ostomy complications in the observation group was 5.45%(3/55), which was lower than that in the control group (P<0.05).

Enhanced recovery after surgery can improve the postoperative adaptation level of patients undergoing robot assisted laparoscopic cystectomy and ileostomy, improve their quality of life, and reduce stoma complications.

To compare the effect of oral mucosal ureteroplasty and traditional stricture resection and anastomosis in the treatment of ureteral stricture.

The clinical data of 40 patients with ureteral stricture admitted to the Second Affiliated Hospital of Anhui Medical University from July 2019 to July 2022 were retrospectively analyzed. According to the surgical methods, 18 patients were divided into the observation group (laparoscopic oral mucosal ureteroplasty) and 22 patients in the control group (laparoscopic resection and anastomosis of ureteral stricture). Both groups were evaluated by imaging examination at 3 and 6 months after operation.

All operations were successfully completed without obvious complications. The surgical time [(198±40) min] and intraoperative bleeding volume [40.0(40.0, 50.0) ml] in the observation group were higher than those in the control group [(170±42) min and 20.0 (10.0, 50.0) ml] (P<0.05). The degree of hydronephrosis in both groups improved significantly after surgery. The separation of renal pelvis in the study group decreased 3 months and 6 months after surgery, which was better than that in the control group, the cure rate 66.67% and effective rate 94.44% of the observation group were higher than those of the control group (54.55% and 86.36%), but there were no significant difference between the two groups (P>0.05).

Both surgical methods have shown good results in treating cases with a narrow segment length of 1.0-2.5 cm. Oral mucosal ureteroplasty may be more suitable for long segment ureteral stenosis due to its low intraoperative anastomotic tension.

To explore the changes in the composition of recurrent urinary tract stones and their influencing factors.

A retrospective analysis was conducted on the clinical data of 115 patients with recurrent urinary tract stones who visited Friendship Hospital in Urumqi from January 2011 to January 2022. Patients with recurrent stones were divided into groups based on whether their stone composition had changed (group with changed composition and group without changed composition). The mutual transformation of stone components in each patient after stone recurrence was calculated.Univariate analysis was used to preliminarily screen for potential risk factors that may affect the change of stone components, then multiple logistic regression analysis was conducted.

Among the 115 patients, 36 experienced compositional changes during stone recurrence, with a total change rate of 31.3%. Among the changes in the composition of various stones, the most prominent was the mutual transformation between calcium oxalate stones and infectious stones, followed by the mutual transformation between calcium oxalate stones and uric acid stones. The results of univariate analysis showed that the age of onset of the first stone ≤40 years old, hyperoxaluria, hyperlipidemia, hypocitruria, and the type of initial stone were the factors that affected the changes in the composition of recurrent stones. After multiple logistic regression analysis, it was found that the age of onset of stones ≤40 years old, the type of stones, and hypocitruria were independent risk factors affecting the changes in the composition of recurrent stones, while hyperlipidemia and hyperoxaluria were protective factors.

About one-third of patients with recurrent urinary tract stones experience changes in the composition of the stones, and the mutual transformation between calcium oxalate stones, infectious stones, and uric acid stones is the most common. Patients with early onset of stones are more likely to experience changes in the composition of stones when combined with hypocitriuria, while those with hyperlipidemia and hyperoxaluria have less changes in the composition of stones when they recur. In clinic, attention should be paid to the metabolic assessment of patients with stones, and comprehensive metabolic assessments should be conducted regularly for high-risk patients and appropriate stone prevention plans should be adjusted.

To explore the clinical effect of the medical nursing cooperation of enhanced recovery model in the perioperative period of single port laparoscopic urinary tract reconstruction.

Fifty patients who underwent single port laparoscopic upper urinary tract reconstruction surgery at the Third Affiliated Hospital of Southern Medical University from January 2021 to January 2022 were selected as the study subjects. They were randomly divided into a control group and an observation group, with 25 cases in each group. The control group patients underwent routine rehabilitation during the perioperative period, while the observation group mainly underwent a perioperative medical nursing cooperation of enhanced recovery model. Evaluate the postoperative recovery, incidence of complications, satisfaction with nursing work, and postoperative quality of life of two groups of patients.

In terms of rehabilitation indicators, the observation group had earlier first time out of bed and anal exhaust time after surgery than the control group (P<0.05); In terms of hospitalization time and expenses, the observation group was better than the control group (P<0.05); There was no statistically significant difference in the incidence of postoperative complications such as urinary tract infection, bleeding, anastomotic fistula, and anastomotic stenosis between the observation group and the control group (P>0.05). The satisfaction level of nursing work and the quality of life score after discharge in the observation group were higher than those in the control group (P<0.05).

Enhanced recovery after surgery can effectively shorten the first time out of bed activity and anal exhaust time of patients undergoing single port laparoscopic upper urinary tract reconstruction surgery during the perioperative period, thereby reducing hospitalization time and costs, increasing patients' confidence in rehabilitation, satisfaction with nursing work, and improving their postoperative quality of life, which is worthy of clinical promotion.

To investigate the safety and efficacy of flexible negative pressure suction sheath-assisted flexible ureteroscopic holmium laser lithotripsy.

Retrospective analysis of the clinical data of 128 patients with upper urinary tract stones treated by flexible negative pressure suction sheath-assisted flexible ureteroscopic holmium laser lithotripsy at Jieyang Minimally Invasive Surgical Hospital from September 2022 to December 2022. During the surgery, 11 F or 12 F flexible negative pressure suction ureteral access sheath were used. The Y-shaped interface outside the body was connected to the negative pressure suction device, and the head end was placed in the renal pelvis and calyx. Under the guidance of flexible ureteroscopy, it was close to the target stone, and sucked out the gravel while crushing the stone until the stone was cleared. After surgery, the 5 F double J tube was routinely retained for 2-4 weeks. Review CT or abdominal plain film on the first day 1-3 months after surgery. The surgical time, stone clearance rate, and incidence of intraoperative and postoperative complications were analyzed.

The success rate of one-time sheathing in 128 patients was 97.7%. The surgical time was 35-120 min with an average of (78±27) min; The average postoperative hospitalization time was (2.7±1.8) d. The stone clearance rate was 94.5%(121/128) after 1-3 months of postoperative follow-up. There was fever in 4 cases, bright red hematuria with blood clots in 1 case after operations, and no other serious complications occurred. The incidence of complications was 3.9%, and all patients were cured.

Flexible negative pressure suction sheath-assisted ureteroscopic holmium laser lithotripsy is safe and effective in the treatment of upper urinary tract stones.

To construct an agarose ex vivo porcine kidney renal carcinoma model and validate its training effectiveness in laparoscopic partial nephrectomy simulation training.

Twenty-one urologists with different laparoscopic surgical experience participated in the training and were categorized into three groups based on their laparoscopic surgical experience: no experience group (group A, n=8), little experience group (group B, n=7), and experienced group (group C, n=6). A renal cancer model using an agarose mixture injected under the envelope of isolated porcine kidneys was constructed. The model was placed into a laparoscopic training simulator and all the trainees performed 6 training sessions. Each trainee's operative time, quality scores, and GOALS scores for each simulated operation were recorded, and the evaluation metrics were compared between the three groups to assess the effectiveness of the model.

During the first training, there were significant differences in the median operative time, median quality score, and median GOALS score between groups A, B, and C (P<0.05). The operative time of Group A and Group B reached the baseline level of Group C at the 4th and 5th training sessions, and the quality score reached the baseline level of Group C at the 2nd training session. The GOALS score reached the baseline level of Group C at the 5th and 4th training sessions, respectively (P>0.05). After 6 training sessions, the evaluation indicators of the three groups have improved to varying degrees.

This study constructed an agarose isolated porcine kidney training model for laparoscopic partial nephrectomy, which is economical and suitable for the training of surgeons with different surgical experiences. The model can improve surgical skills of surgeons and is easy to popularize and promote.