With the release of the 2025-NCCN （V1） Prostate Cancer Diagnosis and Treatment Guidelines，this article interprets the recent updates of the NCCN Prostate Cancer Diagnosis and Treatment Guidelines.The main content of the guidelines updates is the treatment recommendations for very low-risk prostate cancer，recurrence after radical radiotherapy or radical surgery，and metastatic castration resistant prostate cancer.Another focus is the prevention and treatment of bone related adverse events in prostate cancer.Interpreting the new version of the guidelines can provide clinicians with better strategies and treatment choices for the standardized diagnosis and treatment of prostate cancer，thereby further improving patient survival benefits.
The low infiltration of immune cells，especially T cells，in prostate cancer often leads to its classification as an "immune desert"，resulting in poor outcomes with immunotherapy，including immune checkpoint inhibitors.The development of mRNA vaccines has progressed rapidly in recent years.mRNA cancer vaccines have been shown to induce tumor-specific T cells and humoral immune responses that enhance the cytotoxicity against tumor cells.This paper reviews the progress and challenges of mRNA vaccines in prostate cancer，providing references for future research and the development of mRNA therapeutics.
Exosome was first discovered in 1983，it was thought to be a mechanism used by cells to excrete waste in the 1990s.Recent studies have shown that exosomes carry complex components，including proteins，nucleic acids，lipids and other metabolites.Exosomes transport these complex components to nearby or distant cells，participate in cell-to-cell substance exchange and cell communication，and regulate cell homeostasis，immune response and aging.Almost all cells secrete exosomes，so exosomes are also components of the tumor microenvironment，and play an important role in tumor development，metastasis，immune response and therapy.Prostate cancer is one of the most common malignant tumors in male genitourinary system.Exosomes play the role of substance exchange and signal transmission between cells through their contents，which mediates the immune escape process of prostate cancer cells，promotes the development and metastasis of prostate cancer.This article reviews the recent research progress of exosomes in immune escape of prostate cancer cell.
In recent years，due to environmental pollution，dietary changes and other factors，the incidence rate of prostate cancer （PCa） has gradually increased，affecting male's health and life expectancy.Early and accurate diagnosis and treatment are keys to prolonging the survival time of patients.Previously，prostate-specific antigen （PSA） was used for the diagnosis of prostate cancer （PCa），but it was prone to misdiagnosis due to factors such as age and inflammation，necessitating biopsy.However，biopsy is invasive，so new biomarkers are urgently needed to improve the clinical diagnosis of PCa and guide treatment decisions.Exosomes belong to a subclass of extracellular vesicles and can serve as carriers for intercellular information transmission.Previous studies have shown that exosomes contain various proteins and RNAs that are crucial for the progression of PCa，and have potential in PCa diagnosis.This article reviews the biological characteristics of exosomes，their role in the development of PCa，and elaborates on their potential applications in the diagnosis and treatment of PCa.
This article reports a case of localized prostate cancer that progressed to metastatic castration - resistant prostate cancer.The patient experienced three sequential multi - disciplinary therapy （MDT） treatments in the past three years.The article shares the application experience of sequential MDT in prostate cancer management.
Methods
A patient with "5-year post-radical prostatectomy and subsequent endocrine therapy due to biochemical recurrence，resulting in PSA increase" was reviewed.The treatment process and experience were summarized.
Results
The patient initially had localized prostate cancer，underwent surgery and regular follow-up.During follow-up，biochemical recurrence，PSA progression，oligometastatic lesions and multiple metastases occurred.The patient underwent three sequential MDT treatments，receiving adjuvant endocrine therapy，radiotherapy for metastases，novel endocrine therapy and chemotherapy.The patient's condition is currently stable.
Conclusion
The sequential MDT consultation model plays a crucial role in prostate cancer management，providing comprehensive and effective treatment plans for each disease progression.
To investigate the value of contrast enhanced ultrasonography for the diagnosis of prostate cancer using a meta-analysis.
Methods
The Chinese and English literatures on contrast enhanced ultrasonography for prostate cancer diagnosis were searched until October 20，2022.After screening the literature according to the inclusion and exclusion criteria，the relevant data were extracted.Meta-analysis was performed on the literature using Meta Disc 1.4 and Stata 16.0 software.
Results
The combined sensitivity of the diagnosis of prostate cancer by contrast enhanced ultrasonography was 0.77（95%CI： 0.75-0.78），the combined specificity was 0.80（95%CI： 0.78-0.81），the combined positive likelihood ratio was 3.88（95%CI： 3.07-4.91），the combined negative likelihood ratio was 0.28（95%CI： 0.23-0.34），and the combined diagnostic odds ratio （DOR） was 15.59（95%CI： 10.64-22.84），and the pooled area under the curve （AUC） of the summary receiver operating characteristic （SROC） was 0.87（95%CI： 0.83-0.89）.
Conclusion
Contrast enhanced ultrasonography has a high application value for the diagnosis of prostate cancer and can be used as an imaging screening tool for prostate cancer.
To explore the diagnostic efficacy of transperineal cognitive-fusion targeted biopsy for prostate cancer （PCa） in patients with the prostate imaging reporting and data system（version 2.1） （PI-RADS V2.1） score of 5.
Methods
The clinical data of patients who underwent prostate biopsy in the Department of Urology，the Second Affiliated Hospital of Nantong University from January 2018 to July 2022 were retrospectively analyzed.All patients were biopsy naive，and only patients with PI-RADS V2.1 score of 5 undergoing combined biopsy （cognitive-fusion targeted biopsy combined with systematic biopsy） were included in the final analysis.The detection rate of prostate cancer and clinically significant prostate cancer （csPCa） were compared among the 3 biopsy approaches （cognitive-fusion targeted biopsy，systematic biopsy，and the combined biopsy）.In addition，the detection rate of PCa and csPCa of the 3 biopsy approaches were further analyzed according to different total prostate specific antigen （tPSA） and prostate volume （PV） intervals.The operation time of the 3 biopsy approaches were also compared.As some suspicious lesions located in unilateral lobe of prostate，the complementary value of systematic biopsy were analyzed for the pathological results.
Results
176 patients who underwent combined biopsy were included.In 176 patients，the detection rate of PCa and csPCa by cognitivefusion targeted biopsy，systematic biopsy and combined biopsy was comparable （89.2% vs 88.1% vs 89.8%，84.7% vs 79.5% vs 85.8%），with no significant difference （all P＞ 0.05）.In different tPSA intervals（＜4 ng/ml，4≤tPSA≤10 ng/ml，10＜tPSA≤20 ng/ml，20＜tPSA≤100 ng/ml，＞100 ng/ml） and PV intervals（≤30 ml，30-60 ml，＞60 ml），the detection rate of PCa and csPCa by the above 3 biopsy approaches were similar，with no significant difference （all P＞0.05）.The mean operation time of cognitive-fusion targeted biopsy was significantly lower than that of systematic biopsy and combined biopsy （all P＜0.001）.113 patients had suspicious lesions located in unilateral lobe of prostate，and 95（84.1%） of them were diagnosed as PCa by cognitive-fusion targeted biopsy.However，the results of systemic biopsy revealed that 68（71.6%） patients were positive in the contralateral lobe of prostate.
Conclusions
In patients with PI-RADS V2.1 score of 5，performing cognitive-fusion targeted biopsy and omitting systematic biopsy does not decrease the detection of PCa and csPCa，but may miss the pathological information of the contralateral lobe when suspicious lesions located in the unilateral lobe of prostate，affecting the following treatment strategy.
To independently design reusable instrument inventory counting cards and charts and observe the application effectiveness in the management of endoscopic instruments in the disinfection supply center.
Methods
From August 2022 to April 2023，endoscopic instruments collected，cleaned，packaged，and sterilized in the disinfection supply center were included in the study.The study group （n=7 304） and the control group （n=5 863） were divided.The study group used the independently designed reusable instrument counting cards and charts，while the control group used the traditional instrument counting cards.Newly hired staff were trained in the management of laparoscopic instruments using reusable counting cards and traditional instrument counting cards，as well as subsequent instrument management.The training time for new staff，the qualification rate of endoscopic instrument packaging，and the satisfaction rating of operating room medical workers with endoscopic instruments were recorded to compare the differences between the two groups.
Results
The study group showed a shorter training time for new staff.The qualification rate of endoscopic instrument packaging and the satisfaction rating of operating room medical workers were higher than those in the control group，and the differences were significant （P＜0.05）.
Conclusion
The reusable instruments counting cards and charts can shorten the post-training time of the new staff in the disinfection supply center，and improve the qualified rate of endoscopic instrument packaging，and enhance the satisfaction of medical and nursing workers.These findings suggest clinical value and widespread application.
To evaluate effectiveness of the 1 470nm laser enucleation in the management of benign prostatic hyperplasia.
Methods
The clinical data of 46 patients with BPH who underwent 1 470 nm laser enucleation and 40 patients who underwent TURP in the First Hospital of China Medical University from January 2019 to June 2022 were retrospectively analyzed.Age，level of PSA，volume of the prostate，IPSS，QOL，RUV，Qmax，operative time，blood loss，sodium loss of blood，time of bladder irrigation，time of indwelling catheter，in-hospital time and complications were collected.The age，level of PSA，volume of the prostate，IPSS，QOL，RUV，Qmax between the two groups showed no significant difference before operation （P＞0.05）.
Results
All patients received operation successfully.Postoperative follow-up was conducted for 6-30 months.The 1 470 nm group showed advantages in operative time，blood loss volume，the sodium loss of blood，the time of bladder irrigation，the time of indwelling catheter，inhospital time and IPSS after 6 months follow-up （P＜0.05），but the QOL and RUV 6 months after operation showed no difference （P＞0.05）.
Conclusions
1 470 nm enucleation of the prostate is safe，effective，and minimal invasive for the management of benign prostatic hyperplasia.
To observe the safety and efficacy of Allium ureteral of the metal covered stent in patients with complicated ureteral stenosis.
Methods
The data of 18 patients with complex ureteral stricture who were treated with Allium ureteral metal covered stent in the Second People's Hospital of Shanxi Province from December 2019 to October 2022 were retrospectively analyzed.A total of 22 stents were placed.All patients underwent endoscopic Allium stent placement.The changes of hydronephrosis width and renal function before and after the operation were compared，as well as the complications after the placement of ureteral stent.
Results
The ureteral stents were successfully placed in 18 patients，among them，2 patients had multiple more stents for long ureteral stricture.All stents were positioned satisfactorily after operation.The operation time was （101±23） min.The width of hydronephrosis on the affected side was significantly improved 2 months after operation compared with that before operation，with significant difference （P＜0.001）.Similarly，The quality of life of patients was higher than preoperation significantly （P＜0.001）.The early complications of the patients were mainly low back pain （7 cases），fever（2 cases） and gross hematuria （4 cases）.The symptoms basically disappeared after anti-inflammatory，fluid infusion and spasmolysis treatment.In terms of long-term complications，stent displacement occurred in 5 cases，ureteral stricture again occurred in 2 cases，and repeated bladder irritation symptoms occurred in 1 case which removed the ureteral stent finally.
Conclusions
Allium ureteral stent can significantly improve ureteral obstruction，reduce side effects and improve patient tolerance.However，some patients still need to pay attention to complications.At the same time，the long-term effect needs further observation.
To discuss the safety and efficacy of Allium ureteral stent in the treatment of middle-long segment ureteral stricture.
Methods
The data of 23 patients with ureteral stricture of middle-to-long segments who were admitted to the Department of Urology of Geriatric Hospital of Nanjing Medical University from October 2020 to December 2021 were retrospectively analyzed.
Results
The ureteroscopy and retrograde ureteroscopy revealed that the lengths of the segments were 3-15 cm respectively，including 16 cases of unilateral stricture and 7 cases of bilateral stricture.Four steps of retrograde ureterography，ureteroscopy，dilatation of ureteral stricture and ureteral stent implantation were successfully completed under the guidance of C-arm X-ray.All of the 23 cases of dilatation of ureteral stricture were completed with the implantation of Allium ureteral stent.20 cases （86.96%） had good results after ureteral stents were followed up for 34-48 months.
Conclusion
The success rate of endoplasty of ureteral stricture can be improved by the combination of ureteroscopy and X-ray guidance，and the implantation of Allium ureteral stent solves the technical problem of continuous shaping of middle and long segment ureteral stricture after dilatation to some extent.
To investigate the expression and clinicopathological significance of VHL，PBRM1，BAP1 and SETD2 genes in clear cell renal cell carcinoma （ccRCC）.
Methods
104 cases of ccRCC primary tissue and adjacent normal renal tubular tissue samples were collected from the Department of Pathology at Huizhou Central People's Hospital from Jannary 1，2016 to December 31，2021，the expression levels of VHL，PBRM1，BAP1 and SETD2 proteins were detected by immunohistochemistry.Then the correlation and clinicopathological features and prognosis of VHL，PBRM1，BAP1 and SETD2 protein expression in ccRCC were analyzed by statistical techniques.
Results
The positive rates of VHL，PBRM1，BAP1 and SETD2 expression in ccRCC tissues were 51.92%，85.58%，60.58% and 60.58%，respectively，while in normal renal tubular tissues were 89.42%，98.08%，98.08% and 99.04%，the positive rates of these proteins in ccRCC were significantly lower than those of adjacent normal renal tubular tissue （P＜0.001）.Analysis of the correlation between protein expression and clinicopathological characteristics of ccRCC showed that BAP1 and SETD2 negative expression was associated with tumor maximum diameter ＞ 4 cm and TNM stage III-IV （P＜0.05），and BAP1 negative expression was also associated with vascular invasion （P=0.001）.VHL expression deletion accounted for a high proportion of tumors without hemorrhage and necrosis （P=0.009）.Kaplan-Meier analysis showed that the recurrencefree survival of ccRCC patients was negatively correlated with BAP1 loss （P=0.023）.Correlation analysis showed that VHL expression was correlated with BAP1 and SETD2 （r=0.470 and 0.269，both P＜0.05） and SETD2 was correlated with PBRM1 and BAP1 （r=0.244 and 0.357，both P＜0.05）.
Conclusion
The expression of VHL，PBRM1，BAP1，and SETD2 were lost in ccRCC，and there were correlations between different gene expressions.The negative expression of BAP1 and SETD2 was associated with tumor size，high stage，and invasion and metastasis in ccRCC，suggesting that they were potential poor prognostic factors.BAP1 negativie expression may be a prognostic factor for ccRCC patients，with shorter recurrencefree survival，and could be used as new potential therapeutic targets for ccRCC.
To explore the prognostic and therapeutic significance of cholesterol biosynthesis-related genes （CBRG） in prostate cancer （PCa）.
Methods
The differential expression of cholesterol biosynthesis-related genes in PCa and normal tissues was analyzed using the TCGA database.A risk score prognostic model was constructed through LASSO and multivariate Cox regression analysis.The independent prognostic value of the model for PCa was further validated using univariate and multivariate Cox regression analyses.PCa patients were divided into high-risk and low-risk groups based on the median value of the risk score.GSEA analysis was used to observe the differentially enriched pathways between the high-risk and low-risk groups.The CIBERSORT algorithm was employed to assess tumor immune cell infiltration in the high-risk and low-risk groups.Potential drugs associated with the risk score were screened using the GDSC database，and the correlation between the risk score and the half-maximal inhibitory concentration （IC50） of the drugs was analyzed using the Spearman test.Kaplan-Meier analysis compared the disease-free survival （DFS） of patients with high and low expression of characteristic genes.The Wilcoxon test was used to analyze the expression differences of characteristic genes in enzalutamideresistant versus non-resistant cases.
Results
A prognostic model was constructed that included the genes PMVK，ACSL3，ABCG1，HMGCS2，and CYP11A1.This model had areas under the curve （AUC） of 0.74，0.76，and 0.72 for predicting 1-year，3-year，and 5-year DFS，respectively，with AUCs of 0.70 and 0.69 in the validation dataset for 3-year and 5-year DFS，respectively.Clinical independence analysis revealed that this prognostic model has the ability to independently predict DFS in PCa patients，outperforming other clinical pathological features.Further analysis of tumor immune cell infiltration levels in high-risk and lowrisk groups of PCa patients showed that the infiltration levels of CD8+ T cells，follicular helper T cells，and activated NK cells were significantly reduced in the high-risk group，while the infiltration levels of naïve B cells，resting CD4+ memory T cells，regulatory T cells，and neutrophils were significantly increased.Drug sensitivity analysis found that the resistance to six drugs，including enzalutamide and lapatinib，was positively correlated with the risk score.GSEA analysis indicated that the high-risk group was primarily enriched in pathways related to oxidative phosphorylation，ribosomes，and proteasomes.Additionally，survival analysis revealed a significant correlation between the expression of the HMGCS2 gene and patients' DFS，indicating a positive effect on tumor prognosis，and it was significantly downregulated in enzalutamide-resistant patients.
Conclusion
Cholesterol biosynthesis-related characteristic genes are independent prognostic markers for prostate cancer，and the HMGCS2 gene may serve as a potential therapeutic target，providing new insights for precision treatment of prostate cancer.
To summarize the management experience of radical prostatectomy complicated with rectal injury by extraperitoneal laparoscopic approach.
Methods
A retrospective analysis was made of the clinical data of 5 patients who underwent radical prostatectomy complicated with rectal injury through extraperitoneal laparoscopic approach in Shaoxing People's Hospital from January 2014 to October 2022.One patient was pathologically found to have prostate cancer after transurethral prostatectomy，and the other 4 patients were confirmed to have prostate cancer by perineal prostatectomy.The operation time was 1-2 weeks after the puncture.In 3 cases，rectal injury was found directly during the operation and primary rectal repair was performed，of which 2 cases，prophylactic colostomy was performed due to large rectal laceration，poor intestinal preparation and serious contamination of the operating field and 1 case only underwent rectal repair without prophylactic colostomy.Rectal injury was found in the 2 cases after operation，one underwent conservative treatment successfully，the other underwent colostomy，transanal rectourethral fistula repair 4 months later，and coloplasty 3 months later.
Results
All the 5 patients had good healing，no fecal urine，wound infection，pelvic abscess，sepsis，peritonitis，etc.Cystourethrography showed no contrast extravasation.
Conclusions
The rectal injury in radical prostatectomy by extrasperitoneal laparoscopy is most likely to occur in the apical part.The timely detection of rectal injury during the operation and the subsequent laparoscopic primary rectal repair are extremely important.Good preoperative intestinal preparation creates a good opportunity for primary rectal repair，without the need for preventive colostomy.
A common disease in Urology is benign prostatic hyperplasia，which needs to be differentiated from prostate cancer.The initial screening of prostate cancer mainly relies on serum PSA values，but many factors have different degrees of impact on PSA values.PSA is tissue-specific，but it is not a prostate cancer-specific marker.The causes of increased PSA caused by prostate hyperplasia and prostate cancer are different.Therefore，the study of changes in PSA values caused by different prostatic morphologies in the bladder may be of great value in the identification of prostate cancer.
Benign prostatic hyperplasia （BPH） is one of the common diseases in elderly men，often leading to severe bladder outlet obstruction，resulting in recurrent urinary retention，infections，and renal function impairment.The preferred treatment option for rapid symptom relief is surgical intervention.There are many surgical treatment options for BPH，including open resection，minimally invasive transurethral resection，enucleation，vaporization，ablation，stent placement，and robotic surgery.The indications and efficacy of different surgical treatment options vary，and it is essential to individualize the selection of the best surgical approach based on the expertise of the urologic surgeon and the characteristics of the patient.This article reviews the selection of surgical treatment methods for BPH，providing reference for clinical decision-making.
To report a case of right pelvic ectopic kidney with ureteral stenosis，and analyze its diagnosis and treatment.
Methods
The data of one case of right pelvic ectopic kidney with ureteral stenosis in the Third Affiliated Hospital of Southern Medical University was analyzed retrospectively，and summarize the surgical experiences.
Results
After improving the preoperative examination and contraindications of exclusion surgery，the patient with ureteral stricture of pelvic ectopic kidney was repaired and reconstructed under laparoendoscopic single-site surgery.The patient was discharged smoothly on the 8th day after the operation.After a follow-up of five months，there was no expansion of the right ureter，a small amount of localized fluid accumulation in the right kidney，and no urine leakage，urinary tract infection，bladder regurgitation and other complications.
Conclusion
Ectopic kidney is often without clinical symptoms，and can be definitely diagnosed by imaging examination，single-site laparoscopy is a safe and feasible minimally invasive treatment.
Ureteral rupture is a rare and severe complication following extracorporeal shock wave lithotripsy（ESWL）.This article reports a case of a male patient who developed a ureteral rupture in the upper segment after undergoing ESWL for an upper ureteral stone.After treating with the placement of a ureteral stent for continuous decompression and drainage，the patient's symptoms were improved，and the rupture site was healed completely.Subsequently，a second session of ESWL successfully fragmented and expelled the stone.This article also discussed the clinical presentation，pathophysiology，and treatment options for this rare complication，in conjunction with a review of the literature.
Analyze the causes of ureteral stent fracture and retention，explore the treatment of ureteral stent and its complications，improve the vigilance of urological surgeons.
Methods
The data of a patient with ureteral stent fracture in the First Affiliated Hospital of Zhengzhou University were retrospectively analyzed and relevant literature was reviewed.
Results
Intraoperatively，fragmented and residual ureteral stent combined with bladder stones and right hydronephrosis were diagnosed.Cystoscopic lithotripsy and laparoscopic right pyeloplasty were performed，and the stent fragments were removed successfully.
Conclusion
The reasons of ureteral stent fracture include material factors of stent，patient factors and iatrogenic factors.Urological surgeons should be cautious about ureteral stent-related operation，choose appropriate treatment methods according to the degree of stent encrustation，stone burden and renal function，and strengthen communication with patients and follow-up visits to prevent the occurrence of stent neglect.
To investigate the clinical characteristics，treatment and prognosis of primary renal angiosarcoma （PRA）.
Methods
One case of primary renal angiosarcoma complicated with hemorrhage and multiple systemic metastases was retrospectively analysed and relevant literatures were reviewed.
Results
The patient was admitted to our hospital for “acute left abdominal pain for 5 hours”，CT revealed a tumor in his left kidney complicated with hemorrhage，palliative left nephrectomy was performed and pathologic diagnosis confirmed renal angiosarcoma，though chemotherapy，targeted therapy and immunotherapy were carried out.The patient's condition was stable during treatment.After 3 courses of comprehensive treatment，the patient gave up for economic reasons，and dead one-year after operation.
Conclusions
Primary renal angiosarcoma is an exceedingly rare and highly aggressive neoplasm with a poor prognosis，the final diagnosis depends on pathology.Once diagnosed，radical nephrectomy should be performed early，chemotherapy and radiotherapy should be followed after surgery，targeted therapy and immunotherapy may be effective treatments for PRA.
This report presents a case of a retroperitoneal mass with an undetermined preoperative diagnosis，where the patient also had hypertension and was suspected of paraganglioma.We performed a laparoscopic resection of the retroperitoneal mass，the pathological diagnosis confirmed Castleman disease.The patient was successfully discharged after treatment.In conjunction with literature review，we further discuss the characteristics，clinical manifestations，and treatment approaches for Castleman disease.
Cushing's syndrome （CS） and pheochromocytoma and paraganglioma （PPGL）are both endocrine tumors that can lead to dysregulation of adrenal hormones.When these conditions occur during pregnancy，they significantly increase the risk of maternal and fetal complications，and the perioperative surgical risks are exceptionally high.In this report，we present three cases： two of pregnancy complicated by CS and one complicated by PPGL，accompanied by a review of relevant literature.All three patients underwent laparoscopic surgery in the late second or third trimester，without any complications during or after the procedure.The two CS patients received hormone replacement therapy postoperatively，and all three patients demonstrated favorable outcomes during follow-up.Although pregnancy complicated by CS and PPGL is relatively rare and poses substantial surgical risks，laparoscopic surgery can be safely performed in the late stages of pregnancy with appropriate perioperative preparation.
The incidence of bladder stones is much higher in men than in women，and it is rare for women to form huge bladder stones.This article reports a case of a 68-year-old female patient who presented with a 5-year history of abdominal discomfort.Urologic ultrasound showed that after fistula surgery，7.5 cm×8.0 cm curved strong echoes were seen in the bladder cavity，and bladder stones were considered.We performed a cystotomy for lithotripsy and cystostomy surgery.After surgery，the patient was further treated in the Burns and Plastic Surgery Department for poor healing of an infected incision.Completed repair of chronic ulcers of the abdominal wall，repair of bladder defects，cystostomy，and abdominal wall fascia flap plasty in the Burns and Plastic Surgery Department.The patient's wound healed well after surgery and was discharged.
To explore the causes and treatment strategies of extrarenal ectopic placement of the proximal end of a double-J stent during its indwelling period.
Methods
We retrospectively analyzed the clinical data of one case of subcapsular renal stent in Nanchang First Hospital and reviewed relevant literature.
Results
The patient was a 62-year-old woman admitted due to poor glycemic control，who later developed sudden left flank pain and fever，then diagnosed with left partial duplicated kidney and ureteral malformation，upper ureteral stone with infection，and underwent flexible ureteroscopy.Two 5 F double-J stents were placed during the surgery.Postoperatively，the patient experienced significant flank pain.A follow-up CT scan revealed extrarenal ectopic placement of the proximal end of the double-J stent with subcapsular hematoma.After readjustment of the double-J stent position via cystoscopy，the patient's flank pain was alleviated.
Conclusion
Extrarenal ectopic placement of the proximal end of a double-J stent is a rare complication of retrograde double-J stent insertion.Clinicians should be aware of its potential occurrence，standardize the procedure，and avoid or promptly detect and treat it to prevent severe consequences.
This article reports a case of renal pelvis and bladder villous adenoma.The patient was admitted with a history of gross hematuria，urinary frequency，urgency，and dysuria for half a month.CT imaging from an external hospital revealed masses in the right kidney and bladder，suspected to be malignant，along with right renal hydronephrosis and bilateral kidney stones.The patient had a long history of stones and infections，with a serum creatinine level of 159 μmol/L.Initial management involved transurethral resection of the bladder tumor to identify the nature of the tumor，but due to viscous urine，the tumor could not be fully excised，and the pathology diagnosis was bladder villous adenoma.Given that the bladder lesion was benign，priority was given to addressing the right kidney tumor.One month later，the patient underwent robot-assisted laparoscopic right nephrectomy for renal pelvis cancer，and pathology revealed renal pelvis and calyx villous adenoma with high-grade intraepithelial neoplasia.Postoperatively，the patient developed urethral catheter obstruction，and after catheter removal，experienced persistent dysuria，with serum creatinine fluctuating between 180-200 μmol/L.The multidisciplinary consultation by the Guangdong Urological Association led to a recommendation for partial cystectomy，with no immediate plans for radiotherapy or chemotherapy.Two months later，the patient underwent partial cystectomy，with a subsequent reduction in mucus-like urine，improved urinary tract infections，and a serum creatinine level of 169 μmol/L.This case suggests that surgical resection is an effective treatment for urinary tract villous adenomas.
This article reports a case of bilateral multifocal renal carcinoma associated with hyperthyroid heart disease caused by Von Hippel-Lindau （VHL） syndrome.The patient was admitted with a history of "chest tightness and palpitations for 3 months，accompanied by shortness of breath for 3 days，" and was initially diagnosed with hyperthyroid heart disease.Imaging studies revealed multiple renal masses，and after receiving medical treatment，his symptoms improved and he was discharged，the renal mass was untreated.Subsequently，the patient underwent renal mass biopsy and genetic testing at another hospital，which confirmed the diagnosis of VHL syndrome with bilateral clear cell renal carcinoma.Due to the patient's III-level heart failure，he was unable to tolerate surgery and was treated with oral axitinib，but the response was poor.Then the patient was readmitted to our hospital again，after multidisciplinary consultation，underwent catheter-based radiofrequency ablation for rapid atrial fibrillation，resulting in improvement of heart function.A follow-up CT scan revealed locally advanced renal cancer in both kidneys with a right renal vein thrombus.The patient insisted on preserving kidneys and first underwent laparoscopic left partial nephrectomy.After three cycles of axitinib combined with tiragolumab treatment，the right renal cancer was stable on imaging.Through the multidisciplinary consultation by Guangdong Urological Association，it was recommended that the patient undergo right radical nephrectomy due to the complexity and high risk of kidney-preserving surgery for the right kidney.However，the patient insisted on preserving the right kidney.After thorough communication，the multidisciplinary team performed "laparoscopic right nephrectomy + tabletop renal tumor resection + autologous kidney orthotopic transplantation." Postoperatively，follow-up showed no residual tumor in both kidneys，and renal function was well preserved.The patient began receiving atezolizumab-assisted immunotherapy.The tabletop kidney-preserving surgery provided a new treatment option for patients with locally advanced renal carcinoma who strongly wish to preserve kidney function，although future treatment and follow-up still pose challenges.
