To observe the clinical efficacy of microsurgical ligation of spermatic vein and spermatic-inferior epigastric vein anastomosis in the treatment of nutcracker syndrome with a small incision and to evaluate the feasibility, safety and effectiveness of the surgical procedure.

In the outpatient department of our hospital, 8 patients with newly diagnosed left varicocele were diagnosed as nutcracker syndrome by scrotal ultrasound and renal vein color ultrasound evaluation, renal function, urine routine and CT examination. Microsurgical spermatic-inferior epigastric vein anastomosis with a small inguinal incision were performed simultaneous with high level ligation of spermatic vein after combined spinal and epidural anesthesia. The patients were followed up for 6 months.

All the operations were successfully accomplished. Skin incisions were about 2-3 cm.The clinical symptoms such as waist, abdominal pain and scrotal bulging discomfort were significantly resolved or disappeared. Urine routine indicators returned to normal. Sperm concentration and (a+b) sperm motility were significantly improved (P<0.05). Postoperative color Doppler ultrasonography showed that varicocele was cured in all the cases. Smooth blood flow was seen in the left spermatic-inferior epigastric vein anastomotic. The diameters of the proximal left renal vein and the peak velocities in the aortomesenteric portion of the left renal vein were significantly decreased after surgery (P<0.05).

Microsurgical spermatic-inferior epigastric vein anastomosis with its advantages of safety, effectiveness, minimal invasiveness, and simple operation, deserves wide clinical application in the treatment of nutcracker syndrome.

To investigate the predictive value of the nomogram model based on prostate imaging reporting and data system (PI-RADS v2.1) combined with prostate-specific antigen and other parameters for puncture in patients with PI-RADS≤3.

The clinical serological and imaging data of 198 patients who underwent transrectal ultrasound for the first prostate biopsy in Zhongshan People's Hospital from January 2018 to December 2021 were retrospectively analyzed, and the risk scores were analyzed by Logistic multifactor regression. The independent risk factors related to prostate cancer were analyzed, and the rosette model of prostate PI-RADS≤3 was constructed, and the model was evaluated by the subject operating curve, calibration curve and decision curve.

Multivariate logistic regression analysis showed that age (P<0.001), PI-RADS (P=0.017), FPSA/TPSA (P=0.049) and TZV (P<0.001) were statistically significant independent risk factors for prostate cancer. The fusion model based on multivariable construction had the best performance, with (AUC=0.823, 95%CI=0.762-0.885), sensitivity 81.3%, specificity 78.8%, accuracy 79.8%. The calibration curve showed a good agreement between the predicted probabilities of fusion model and pathologic findings. The decision curve model had good clinical application value.

The nomogram and prediction model can better predict the risk of prostate cancer before surgery.

Partial nephrectomy has been recommended by various guidelines as the preferred surgical procedure for T1a stage renal tumors. However, due to its special anatomical location near renal blood vessels and the renal collecting system, partial nephrectomy for renal portal tumors has always been recognized as a challenging surgery in Urology. This article summarizes the surgical techniques and experience of this procedure, and believes that through comprehensive preoperative evaluation, appropriate surgical approach selection, improved tumor resection and wound reconstruction techniques, the surgery can be safely and effectively completed, achieving the "three consecutive victories" goal of negative margins, shortened ischemia time, and reduced perioperative complications.

To analyze the clinical characteristics and methods of diagnosis and treatment of primary rare kidney neoplasms, in order to improve the understanding of primary rare kidney neoplasms.

The data of three cases of primary rare kidney neoplasms confirmed pathologically in the Seventh Affiliated Hospital of Sun Yat-sen University from May 2018 to September 2018 were analyzed retrospectively.

Case 1 was a 54-year-old woman, CT scan showed a large soft tissue mass in the left kidney and several enlarged lymph nodes around renal hilum in a routine check-up a week ago, laparoscopic radical left nephrectomy and lymphadenectomy were then conducted and the mass was pathologically proved to be mucinous tubular and spindle cell carcinoma, no recurrence or metastasis was observed during a 3-month follow-up. Case 2 was a 44-year-old man, presented with a 1-month history of left flank abdominal pain, MR examination revealed a huge space-occupying lesion in the left kidney. In consideration of inconvenient laparoscopic operation, open exploratory surgery was performed. During the operation the descending colon was discovered adhered to the lesion apparently, consequently radical left nephrectomy and partial resection of descending colon were conducted, and the histopathology was proved to be carcinosarcoma. Local relapse and extensive intraperitoneal metastasis were observed a month later, auxiliary chemotherapy with paclitaxel combined doxorubicin and targeted therapy with apatinib were executed according to oncologist’s advices, no further progression was observed till now. Case 3 was a 70-year-old man, presented with left flank pain and gross hematuria for three months, CT scan displayed irregular low-density focus in the upper pole of the left kidney and multiple retroperitoneal enlarged lymph nodes. Laparoscopic radical left nephrectomy and lymphadenectomy were carried out and the histopathology was unexpectedly proved to be high grade invasive urothelial carcinoma, the further nephroureterectomy was recommended but the patient refused it, neither recurrence nor metastasis was observed during a 6-month follow-up.

The clinical symptoms and imaging manifestations of primary rare kidney neoplasms are frequently lack of specific and easily to be misdiagnosed, more attention should be paid to distinguish from other diseases. Radical excision is the main therapeutic method, some types of neoplasms have a poor prognosis and close follow-up is essential, auxiliary radiotherapy, chemotherapy or targeted therapy should be performed postoperatively as early as possible if it is necessary.

To analyze the risk factors for hyperlactatemia in patients undergoing retroperitoneoscopic surgery.

The clinical data were collected from patients who underwent retroperitoneoscopic surgery in the First Hospital of Shanxi Medical University from January 1, 2018 to June 30, 2019. The patients were divided into high lactate group and normal lactate group according to the lactate value during the operation. To analyze the relevant data by univariate analysis and multivariate Logistic regression analysis.

Among 726 patients, 76(10.5%) cases lactate value increased. Univariate analysis showed that the liver Child-Pugh score, serum creatinine concentration, BMI, duration of operation and pneumoperitoneum, bladder pressure during the pneumoperitoneum, occurrence of prolonged hypotension and the cases of pheochromocytoma resection in the high lactate group were higher than those in the normal lactate group, the urine volume was lower, with statistically signficant differences (P<0.05). Multivariate Logistic regression analysis showed that the liver Child-Pugh score(OR=9.776, 95%CI 4.689-20.383, P<0.001), the serum creatinine concentration (OR=1.134, 95%CI 1.083-1.189, P<0.001), the duration of pneumoperitoneum (OR=1.021, 95%CI 1.001-1.042, P=0.043), pheochromocytoma resection (OR=5.146, 95%CI 1.229-21.543, P=0.025), prolonged hypotension (OR=12.956, 95%CI 2.028-82.753, P=0.007) were risk factors of hyperlactatemia for retroperitoneoscopic surgery.

The preoperetive liver Child-Pugh score, serum creatinine concentration, pneumoperitoneum duration, pheochromocytoma resection and prolonged hypotension are the independent risk factors of hyperlactatemia in retroperitoneoscopic surgery.

To investigate the success rate of ureteral access sheath (UAS) insertion and efficacy of stage I flexible ureteroscopic lithotripsy (f-URL) in treatment of upper urinary calculi without indwelling double-J stent previously.

A total of 255 patients with upper urinary calculi treated by stage I f-URL in our hospital from January 2018 to June 2020 were analyzed retrospectively. The success rate of UAS insertion and surgery, the stone-free rate and the incidence of complications were calculated.

The success rate of UAS insertion was 92.9%(237/255), and the success rate of one-stage operation was 85.5%(218/255). The success rate of UAS insertion in 10/12 F group was 91.6%(141/154), there was significant difference in gender between successful and unsuccessful patients (P<0.05). The success rate of UAS insertion in 12/14 F group was 95%(96/101), there was significant difference in hydronephrosis and preoperative renal function between successful and unsuccessful patients. Further multivariate logistic regression analysis showed that gender (P=0.014) were the risk factors for the failure of UAS insertion.The stone-free rate was 88.5%(177/200) three month after the operation. The total complication rate was 23.5%(60/255). During operation, there were 25 cases of grade 1 ureteral injury, 6 cases of grade 2 ureteral injury and 1 case of grade 3 ureteral injury. There were 22 cases of postoperative fever, including 5 cases of systemic inflammatory response syndrome and 1 case of urosepsis. Subcapsular hematoma occurred in 1 case. There were 5 cases of renal insufficiency, but no serious complications such as septic shock, ureteral stone street and ureteral stricture.

Stage I f-URL without indwelling double-J stent has a high success rate of UAS insertion and surgery with a high stone-free rate, is also a safe and reliable procedure. Female patients are more likely to experience intraoperative success to insert UAS.

To report our initial experiences of 6 successful extraperitoneal three-port laparoscopic burch colposuspensionin in the treatment of recurrent stress urinary incontinence after tension-free vaginal tape-obturator (TVT-O).

six female patients with recurrent stress incontinence after TVT-O were treated by extraperioneal three-port laparoscopic burch colposuspension from Jun 2015 to september 2019. Extraperitoneal space was created with CO₂ through a 10 mm midline port 2-cm below the umbilicus. A pair of figure-of-eight sutures was inserted at the level of midurethral and urethrovesical junction, fixing them to Cooper's ligament on each side with proper tension.The operation duration, bleeding volume and hospital stay were observed.

The average surgery time was (37±6)min, blood loss (17±7) ml, postoperation hospitalization time (4.5±0.5) d. These 6 cases were then followed up in the next 3-45 months. All cases were cured. No complication occurred.

The extraperioneal laparoscopic Burch operation is a satisfactory procedure with the advantages of minimal invasion, quick recovery and short hospitalization in the treatment of recurrent stress urinary incontinence after TVT-O.