To present the surgical technique of 1470 nm diode laser antegrade enucleation of the prostate for benign prostatic hyperplasia (BPH) and evaluate its clinical efficacy.

30 consecutive patients with BPH who underwent transurethral 1470 nm diode laser antegradeenucleation of the prostate at our institution from September 2016 to January 2017 were reviewed. The mean age of the patients was (72±9) years (range 53 to 86 years), and the prostate volume was (54±25) ml (range 27 to 120 ml). All procedures had been accomplished with antegrade approach: Firstly, two grooves deep into the capsule were created from bladder neck to 1 cm proximalto verumontanum at 5 and 7 o’clock direction. After the median lobe was vaporized, the distal margin of prostate was deepened to the capsule plane and extended to 9 and 3 o’clock position. Then the adenoma at 12 o’clock were vaporized to expose the capsule from the bladder neck to the proximal urethral sphincter. Subsequently, two lateral lobes were enucleated along the capsule with antegrade approach, respectively. The adenoma >80 ml were sucked by tissue morcellator and the adenoma <80 ml were vaporized segmentally.

The mean operation time was (65±14) min, and the median estimated blood loss [M(QR) ] was 10 (15) ml. The median postoperative hospital stay and mean duration of catheterization were 4 (3.8) d and (4.5±1.5) d (range 2 to 8 d), respectively. Preoperative and postoperative mean hemoglobin and serum sodium concentration were (129±23) versus (125±20) g/L and (141±3) versus (140±3) mmol/L, respectively, where the differences were not statistically significant. The mean IPSS score, QOL sore and Qmaxpreoperative and 1 month postoperative were (22±6) versus (8±3), (5.2±0.7) versus (1.9±0.9), and (7.8±2.1) versus (17.2±3.9) ml/s, respectively, with significantly differences. No patient experienced postoperative complications such as incontinence or urethral stricture during a median follow-up of 2.3(2.8) months (range 1 to 4 months).

Transurethral 1470 nm diode laser antegradeenucleation of the prostate is safe and effective for treatment of BPH which could provide rapid postoperative rehabilitation.

To evaluate the clinical effectiveness of prostate sparing in laparoscopic radical cystectomy with ileal conduit.

The clinical data of 10 male patients who underwent prostate sparing laparoscopic radical cystectomy with ileal conduit from January 2012 to June 2015 were retrospectively analyzed. The age of the patients ranged from 37 to 45 years, and the median age was 41 years old. The clinical stage were all T2N0M0.

Ten patients were all operated successfully. The mean operative time was 250 minutes (range 220-340 min). The blood loss was ranged from 350 ml to 800 ml, the median blood loss was 480 ml. They were followed for 6 to 24 months, 9 patients can have erection and ejaculation after 6 months. One patient had distant metastasis and was given chemotherapy, and still alive now.

Based on our early follow-up, the procedure of laparoscopic prostate sparing radical cystectomy with ileal conduit obtain good functional results, but the patients must be strictly screened, sparing the function of erection and ejaculatory can greatly improve the patient's quality of life.

To evaluate the efficacy, safety and operating skills of Sun's tip-flexible ureterorenoscopy(tf-URS) with holmium laser in the treatment of renal and upper ureteral calculi.

Retrospective analysis of clinical data of 82 patients with renal and upper ureteral calculi were treated with tf-URS with holmium laser in our hospital, including 52 male (63.4%) and 30 female (36.6%), and 26 cases with upper ureteral calculi(31.7%), 56 cases with renal calculi(68.3%). The age ranged from (37±11) years old. Stone size was (1.4±0.6) cm. All the patients were diagnosed by ultrasound, CT or IVP. The operative time, postoperative complications and calculi clearance rate were observed.

The success rate of insertion of tf-URS was 95.1% (78/82) in the first time. Four patients suffered ureterostenosis or ureteral distortion was changed to laparoscopy or PCNL. The success rate of lithotripsy was 97.4%(76/78) . The rate of total stone clearance was 96.1%(73/76) at 4 weeks, and 3 cases underwent ESWL. No serious complications occurred.

The tf-URS with holmium laser in the treatment of renal and upper ureteral calculi is safe, reliable and it has high success rate with low incidence of complications.

To investigate the effect of prostate volume on the outcomes of transurethral resection of the prostate (TURP).

A retrospective study was conducted to summarize the cases who received TURP for BPH from January 2012 to July 2014. These patients were divided into three groups according to different prostate volume (PV) (Group A: PV<40 ml; Group B: PV=40~80 ml; Group C: PV>80 ml). The international prostate symptom score (IPSS), qulity of life score(QOL), maximum urine flow(Qmax), average flow rate (Qave), residual urine volume (RUV), prostate-specific antigen (PSA) and the postoperative complications in all patients were compared between pre- and post-surgery.

Group A: 51 patients, (71±10) years old, Group B: 107 patients, (71±9) years old, Group C: 62 patients, (72±7) years old. No statistically significant differences were observed on all indicators of preoperative and complications after TURP(P>0.05). All patients urination improved after surgery, but among the three groups, only the Qmax and Qave changes were statistically significant (P<0.05), no significant difference between the IPSS, QOL and RUV changes (P>0.05).

Prostate volume does not affect the choice of TURP, also does not affect the improvement of dysuria symptoms and quality of life, but urinary flow rate improvement was significant for moderate benign prostatic hyperplasia (PV=40~80 ml).

To investigate the effect of preoperative indwelling double J stent for flexible ureteroscopic lithotripsy.

Ninety-eight patients with renal calculi or ureteral calculi treated by flexible ureteroscopic lithotripsy in our hospital from January 2014 to August 2015. The patients were divided into two groups according to whether received indwelling double J stent 3-5 days before operation. The difference of successful rate, operation time, postoperative complications, hospitalization time and cost were analyzed.

The operation time of the group received indwelling double J stent 3-5 days was shorter [(44±13) min vs (54±12) min, P<0.05], but got more expensive hospitalization cost [(20 183±3 426) yuan vs (15 655±3 542) yuan, P<0.05]. There were no significant differences in the success rate [98%(49/50) vs 89.6%(43/48), P>0.05], postoperative complications and postoperative hospitalization time between the two groups.

The preoperative indwelling double J stent can significantly shorten the operation time of flexible ureteroscopy, but the effect on flexible ureteroscopy success rate needs further study.

To evaluate the safety and efficacy of minimally invasive percutaneous nephrolithotomy (MPCNL) in patients with autosomal dominant polycystic kidney disease (ADPKD) and renal stone.

The clinical data of patients with ADPKD and renal stone who underwent MPCNL in our hospital between January 2006 and December 2015 were analyzed retrospectively.

twenty-seven renal units in 26 patients were included in our study. Twenty-five patients were performed in one stage MPCNL and one patient underwent second-stage MPCNL. The overall stone clearance rate was 88.9% (24/27). Three patients received ESWL because of residual calculi. The mean operation time was (68±34) min (range 20~140 min) and the mean blood loss was (57±49) ml (range 10~250 ml). The mean preoperative creatinine (Cr) and postoperative Cr level were (292±51) μmol/L and (219.8±33.6) μmol/L, (t=2.388, P=0.025). Two cases had fever postoperatively and four cases received blood transfusion because of hemorrhage.

MPCNL is a safe and effective approach for management of renal calculi in patients wih ADPKD.

To explore techniques of the double J stent placement in the treatment of upper ureteral calculi during retroperitoneal laparoscopic ureterolithotomy (RLU).

The clinical data of 35 cases with upper ureteral calculi who undwent retroperitoneal laparoscopic ureterolithotomy in Huai'an Hospital Affiliated to Xuzhou Medical College, from July 2013 to July 2015 were retrospectively analyzed. The double J stents were placed under the guidance of wire combined with appropriate manual operation technique, and the experiences of placement were summarized.

In all cases the double J stent placement were successful, and the operation time ranged from 2 to 9 min (mean 4 min). The position of the double J stent was showed normal by the KUB after operation. The double J stent was removed one month after operation, and no cases of leakage of urine and infection were found.

This approach of double J stent placement during laparoscopic is simple, fast and effective, without special instruments, which is worthy of clinical application.

To evaluate the clinical efficacy between balloon dilatation and holmium laser in combination with balloon dilatation in the treatment of ureteral stenosis after surgical removal of impacted ureteral calculi.

Clinical data of 60 patients presenting with ureteral stenosis after surgical removal of impacted ureteral calculi in Lanzhou General Hospital of Lanzhou Military Area Command between February 2011 and April 2015 were retrospectively analyzed. Among them, 35 patients underwent balloon dilatation (the dilatation group) and 25 received holmium laser combined with balloon dilatation (the combined group). Clinical efficacy was assessed by comparing the effective rate, the degree of renal collecting system separation and ureteral width between the two groups.

No statistical significance was noted in the baseline data between the two groups. All 60 patients successfully completed the surgery. In the dilatation group, the effective rate was significantly lower than the combined group (54.3% vs 80.0%, P<0.05). In the dilatation group, preoperative and postoperative values of renal collecting system separation were (3.8±0.5) cm and (2.5±0.5) cm with statistical significance (P<0.05), and the ureteral width was (2.5±0.9) mm and (3.8±0.4) mm with statistical significance (P<0.05), whereas no statistical significance was observed in the preoperative and postoperative length of ureteral stenosis [(1.2±0.3) cm vs (0.9±0.5) cm, P>0.05)]. In the combined group, the value of renal collecting system separation [(3.7±0.6) cmvs (2.0±0.8) cm], ureteral width [(2.3±0.7) cm vs (19.5±0.8) mm] and ureteral length [(1.1±0.5) cm vs (0.5±0.3) cm] significantly differed before and after surgery (all P<0.05). Postoperative ureteral width, ureteral length and the value of renal collecting system separation significantly differed between thetwo groups (all P<0.05).

Compared with balloon dilatation alone, holmium laser in combination with balloon dilatation yields higher clinical efficacy in the treatment of ureteral stenosis after surgical removal of impacted ureteral calculi.

To compare the efficacy between Sun's ureteroscope and flexible ureteroscope for renal calculus(≤2 cm).

The data of 123 patients with kidney stones(≤2 cm) treated in our hospital from January 2014 to March 2017 were analyzed. Sixty patients were treated Sun's ureteroscopic lithotripsy (observation group), while the other sixty-three patients were treated with flexible ureteroscopic lithotripsy (control group). The success-rate of endoscopic insertion, endoscopic insertion time, the success rate of lithotripsy, stone-free rate, postoperative complication rate, postoperative hospital stay, hospitalization expenses in two groups were evaluated.

The differences of the rate of endoscopic insertion, the success rate of lithotripsy, stone-free rate and postoperative hospital stay between the two groups weren't statistically significant (P>0.05). There were significant differences in endoscopic insertion time, postoperative complication rate, hospitalization expenses between the two groups (P<0.05).

The Sun's ureteroscope is safe and effective in the treatment of renal calculi. It has its unique advantages and deserves further aplication in clinical practice.

To study the effect of intra-operative electrical nerve stimulation on preservation of pelvic autonomic nerve during radical laparoscopic proctectomy, and investigate its effect on protection of urinary and sexual functions.

Ninety two patients who underwent radical laparoscopic proctectomy between October 2014 and October 2016 in the Third Affiliated Hospital of Sun Yat-sen University were included prospectively. The experimental group underwent intra-operative electrical nerve stimulation on pelvic autonomic nerve during operation. In contrast, the pelvic autonomic nerve of the control group was assessed visually. Urinary function was evaluated by residual urine volume (RUV), international prostatic symptom score (IPSS) and recatheterization rate. Male erectile function was evaluated using the international index of erectile function (IIEF-5) scale.

Compared with the control group, the experimental group required more operative time [(146±24) min vs (125±28) min, P<0.01], and less deterioration in postoperative RUV [7 days:(32±16) ml vs (52±19) ml, P=0.005]; 1 month: [(26±13) ml vs (40±18) ml, P=0.026], lower IPSS [(7 days: (8±4) vs (12±5), P=0.008; 1 month: (6±3) vs (8±4), P=0.021] and higher IIEF score[3 months: (10.7±2.2) vs (9.3±2.4), P<0.01; 6 months: (15.4±1.8) vs (13.2±2.0), P<0.001].

Intra-operative electrical nerve stimulation is feasible for assessment of pelvic autonomic nerve during radical laparoscopic proctectomy. It is more effective in protection of urinary and male erectile functions.

To compare the clinical data of the laparoendoscopic single-site nephrectomy(LESS) and traditional three holes laparoscopic nephrectomy, for investigating the safety and effectiveness of single-site laparoscopic in the urological utility.

The operative time, intraoperative blood loss, postoperative recovery time of intestinal ventilation, postoperative indwelling drainage tube time, postoperative hospitalization days of clinical data of 35 cases were analyzed retrospectively, 15 cases underwent single-site laparoscopic nephrectomy, and 20 cases underwent traditional laparoscopic nephrectomy (TCL).

There was no difference between the 2 groups in the age [(53±13) years old vs (51±11) years old, P=0.773], body weight[(22.1±2.6) kg/m² vs (22.7±3.3) kg/m², P=0.535], gender distribution, classification of pathology, operative access, intraoperative blood loss[(142±74) ml vs (138±60) ml, P=0.861)], recovery of intestinal ventilation [(2.0±0.7) d vs (2.0±0.6) d, P=1.000], postoperative indwelling drainage tube [(3.5±0.9) d vs (3.2±1.1) d, P=0.453] and hospital stay [(7.1±2.2) d vs (6.8±1.6) d, P=0.729]. Fourteen of the 15 patients in the LESS group underwent the procedure successfully without additional trocar placement. LESS nephrectomy took longer operative time than TLC group [(231±52) min vs (157±30) min, P<0.01). No wound infection occurred after LESS nephrectomy. No access site hernia was noted in the patients in the LESS group at short-time follow-up, and the scar was also small.

The LESS nephrectomy, whether via lumber or abdomen, is safe and effective comparable to TCL, which can satisfy the beautiful wish of patients to the incision, but the learning curve and operative time was long, with the improvement of surgical technique and the operative instruments, perhaps can effectively solve the problem.

To evaluate the effectiveness of flexible ureteroscopy (FURS) for treating kidney stones and the risk factors of urosepsis following flexible ureteroscope with holmium laser.

The data of 66 patients with kidney stones who underwent flexible ureteroscopy with holmium laser at our hospital from January 2015 to September 2016, including gender, age, comorbidity, urine analysis results, urine culture results, blood test results, stone size, and operative duration were analyzed retrospectively. Patients with and without urosepsis were assigned to groups A and B, respectively. The dependent variables were postoperative urosepsis, and the risk factors for urosepsis following flexible ureteroscope were assessed using Chi-square tests and multivariate logistic regression analyses.

All surgeries were successfully completed. The incidence of urosepsis after FURS was 13.6% (n=9). Univariate analyses of groups A and B indicated that pyuria, stonesize, operative duration, and infectious stones were significantly different between two groups (P<0.05). Multivariate logistic regression analyses indicated that pyuria (P=0.019), operative duration (P=0.021), and infectious stones (P=0.032) were independently related to urosepsis.

Pyuria, operative duration, and infectious stones were risk factors for urosepsis following flexible ureteroscopy.

To evaluate the clinical efficacy of three different surgical approaches in the treatment of cryptorchidism.

One hundred and fifty nine patients (213 testes) diagnosed of cryptorchidism in different positions were admitted to our hospital from January 2010 to June 2017. The ages ranged from 5 months to 14 years. Three different surgical treatments (laparoscopic orchidopexy, scrotal incision surgery and open inguinal surgery) were performed in these cases according to the preoperative and intraoperative physical examination, the development of testes and so on. The effects and complications of these three treatments were compared.

Ninety cases underwent laparoscopic orchidopexy, 61 cases underwent scrotal incision surgeries plus laparoscopic approach to find patnet processus vaginalis(PPV), and 62 cases underwent open inguinal surgeries. Among 105 patients diagnosed of unilateral cryptorchidism, 85(80.95%) were found with PPV in the same side and 40(38.10%) with CPPV. While 31 cases (57.41%) were found bilateral PPV in 54 patients with bilateral cryptorchidism. Two testes were removed because of dysplasia. The rest were fixed at the bottom of scrotum without tension. The follow-up endured for 3 months to 6 years. One case was found recurrence. No testicular atrophy or retraction was found in all patients. There was no significant difference among the three surgical approaches in the treatment of cryptorchidism (P>0.05).

Laparoscopic orchidopexy is recommended as the first choice for intra-abdominal testes, and scrotal incision surgery is better for low cryptorchidism. Open inguinal surgery still has a major value and significance in diagnosing absence or dysplasia of testes.

To provide a systematic review and meta-analysis of studies comparing laser versus transurethral resection of bladder tumor (TURBT) for non-muscle invasive bladder cancer (NMIBC).

This study comprehensively searched PubMed, Scopus, Web of science, Cochrane library, and performed a systematic review and meta-analysis of all randomized controlled trials (RCTs), retrospective comparative studies and prospective studies assessing the two techniques.

Nine studies including 4 RCTs, 4 retrospective studies and 1 prospective study fulfilled the predefined inclusion criteria and were included in the final analysis. These studies included data of 1396 cases (694 for lasers and 702 for TURBT). Although there was no significant difference between lasers and TURBT for operation time (WMD=1.63, 95%CI=-1.44~4.70, P=0.30), lasers provided shorter hospital stays (WMD=-1.11, 95%CI=-1.71~- 0.50, P=0.0004) as well as lower complication rates. What's more, the recurrence rates showed no significantly difference when we took a one-year follow-up (OR=0.87, 95% CI=0.59~1.27, P=0.47), or even two-year follow-up (OR=0.70, 95% CI=0.46~1.09, P=0.11).

Laser is not only safer, but also has the same efficacy as TURBT when dealing with NMIBC. And it should be recommended when minimally invasive therapy is necessary.

To explore the effectiveness and safety of holmium laser lithotripsy under ureteroscopy during pregnancy.

From August 2011 to May 2016, 56 patients with ureteral calculi during pregnancy underwent ureteroscopic lithotripsy with holmium laser , and were inspected the serum progesterone and beta human chorionic gonadotropin (β-HCG) in perioperative period in Dongguan Houjie Affiliated Hospital.

The procedures in 49 cases were sucessful one-time (87.5%), and 5 cases had partial fragments that flowed back to kindey (8.9%). Two cases failed to reach the calculus (3.6%), but the 4 F double J tubes were placed successfully. Lumbar abdominal pain, fever and other symptoms disappeared in all the patients after operation. The serum progesterone and β-HCG didn't decreased on the first day and the third day postoperatively. No placental abruption, threatened abortion, abortion complications were found in all cases.

Ureteroscopic lithotripsy with holmium laser during pregnancy for ureteral calculi is safe, effective, little interference on pregnancy, and worthy of clinical popularization and application.

To explore the minimally invasive means for the treatment of ureteral calculi of the fourth lumbar vertebrae.

The clinical data of 358 cases were analyzed retrospectively. One hundred and eighty-seven cases were treated by minimally invasive percutaneous nephrolithotomy (MPCNL), 86 cases were treated by transurethral ureteroscopic pneumatic or holmium laser lithotripsy(URL), 23 cases by combination of percutaneous nephrostomy and transurethral ureteroscopic lithotripsy, 62 cases were treated by retrograde intra-renal surgery (RIRS). The efficacy and complications were compared.

The stone-free rate of one time was 96.3%, 90.7%, 100% and 100%, respectively. Residual stones were removed by adjuvant therapy. Fastest recovery and shortest hospital stay was observed in RIRS group. No severe complication were noted during 1 to 28 months follow-up.

MPCNL, URL, combination of percutaneous nephrostomy and transurethral ureteroscopic lithotripsy, and RIRS are common treatments for ureteral calculi of the fourth lumbar vertebrae. Combination of percutaneous nephrostomy and transurethral ureteroscopy can be applied for some refractory cases. With the development of RIRS, RIRS is the first choice of ureteral calculi of the fourth lumbar vertebrae with mild to moderate hydronephrosis.

To investigate the molecular mechanism of ACSL3 expression in enhancing prostate cancer (PCa) cell proliferation, and to explore the potential value of ACSL3 expression in prognosis of the recurrence and metastasis of PCa.

Western blot was used to detect the expression of ACSL3 in different PCa cell lines. The pCDNA3.1(+)-Flag-ACSL3 plasmids were transfected into prostate cancer cells. And then, MTT assay was used to detect the alteration of cell proliferation. After over expression of ACSL3, western blot was used to detect the expression of Akt, phosphorylated Akt (p-Akt) and Matrix Metalloproteinase-9 (MMP-9) in cancer cells. Immunofluorescence staining was carried out to detect whether there was a co-localization between ACSL3 and Akt protein. Immunohistochemistry (IHC) assay was used to evaluate ACSL3 expression in tissues of PCa patients with different Gleason score.

Western blot showed that ACSL3 protein got lower expression in localized prostate cancer cell line 22Rv1, while higher expression in hormone-independent PCa cells than in hormone-dependent PCa cells. The MTT assay demonstrated that the cell proliferation was significantly increased after ACSL3 overexpression. Moreover, overexpressing ACSL3 can also enhance p-Akt, MMP-9 expression. Immunofluorescence staining implied that there was a co-localization between ACSL3 and Akt in 22Rv1. In addition, IHC results revealed that the expression of ACSL3 protein was enhanced with the increasing of Gleason score, result in higher ACSL3 expression.

ACSL3 may induce the activation of PI3K/Akt/MMP-9 signaling pathway via the interaction between ACLS3 and Akt protein, which can enhance the proliferation of prostate cancer cells. Meanwhile, the increase expression of ACSL3 protein was correlated with higher Gleason score in patients with PCa.