To explore the basic information, pathology and clinical characteristics, diagnosis and efficacy of treatment.

The data of a 30-year-old man were analyzed at the Department of Urology of Guangdong Provicial People’s Hospital with an unexpected discovery of the left adrenal mass 1 month ago. The preoperative enhanced CT showed: in the left adrenal region, a round cystic low density mass was found, which was considered to be a left adrenal cystic mass. Retroperitoneal laparoscopic resection of the left adrenal gland tumor was performed for this patient, and intraoperative frozen examination showed that it was cystic lesions, which got no evidence of malignancy.

The intestinal duplication cyst was diagnozed after operation by pathology and clinical features. The patients recovered very well, and was followed, treatment associated with the best long-term outcomes.

Retroperitoneal intestinal duplication is rare in clinical, It has atypical clinical manifestation and not specific in imaging and laboratory examinations. Therefore, it is easy to be misdiagnosed in clinical practice. The clinical pathological diagnosis will be helpful, and surgical resection is the best treatment.

To report the preliminary experience of retroperitoneal laparoscopy combined with flexible ureteroscopy for the treatment of retrocaval ureter and right kidney stones, and explore the surgical skills and clinical efficacy.

The therapeutic strategy of two patients with retrocaval ureter and right kidney stones was reported and analyzed. In the CT urography of two patients, the right ureter showed a typical S-type change combined with right kidney stones. These patients were underwent retroperitoneal laparoscopic ureteroplasty and flexible ureteroscopic lithotripsy.

Two patients were diagnosed clearly and the procedures were successful. There was no conversion to open surgery, the operation time was 115 min and 108 min respectively. The intraoperative blood loss was 30 ml and 20 ml respectively. The intestinal function was restored on the first postoperative day. The right perirenal drainage tubes were removed on the third day after the operation. There was no residual stone in right kidney, and the double J stents were in normal position showed by KUB. The patients were discharged on the 5th day and the stents were removed in one month after operation.

Retroperitoneal laparoscopy combined with flexible ureteroscopy should be considered to be the first-line treatment for retrocaval ureter and right kidney stones.

To discuss the clinical features and treatment of primary renal synovial sarcoma(PRSS).

The data of a rare case of PRSS were analyzed retrospectively, a comprehensive review of the literature was presented.

The patient was treated by left radial nephrectomy. The result of pathology indicated PRSS.

There was no typical clinical manifestation or imaging feature of PRSS. We depended pathology and immunohistochemical examination to diagnosis PRSS, and SYT-SSX fusion gene was also useful. We proposed multimodality treatment measures including surgery and anthracycline-based chemotherapy.

To explore feasibility and safety of minimally invasive percutaneous nephrolithotomy (MPCNL) under intercostal nerve block combined with local anesthesia.

From October 2018 to November 2019, under the guidance of ultrasound, intercostal nerve blocks were performed at the intersection of the 10th, 11th, and 12th ribs of the affected side with the spine. 5 ml of 0.5% bupivacaine (containing 1/1 000 epinephrine) was injected at each site, and then local infiltration anesthesia on the selected puncture channel (2% lidocaine 10 ml + normal saline 15 ml mixed solution about 10 ml) was performed. Ultrasound guided puncture and one-step expansion of MPCNL was implemented, visual analogue scale (VAS) was used to assess pain severity.

The operations were successfully completed in 38 cases, no one needed to change the method of anesthesia, no serious complications occurred, and no case was converted to open surgery. The mean VAS scores during surgery and after 2 h, 4 h, and 24 h were 2.6, 2.2, 1.8, and 1.3 points respectively, the overall stone removal rate at 9 weeks was 91.3% (21/23).

Selecting suitable cases, MPCNL under intercostal nerve block combined with local anesthesia is simple, safe and efficient.

To explore the case selection and intraoperative decisions in tubeless percutaneous nephrolithotomy(PCNL).

From January 2017 to March 2018, the data of 364 consecutive cases were analyzed before PCNL. According to the comprehensive preoperative evaluation, some patients were selected for tubeless PCNL. The selected patients were divided into two groups according to whether the nephrostomy tube was placed in the final. The postoperative hospitalization days, stone clearance rate, intraoperative blood loss, visual pain score and perioperative complications were evaluated.

42 cases were selected for tubeless PCNL before operation, and 37 cases were done in the final. Stone clearance rate was 100% in both groups. No differences in grade Ⅰ complications (P=0.424). The mean operative time (P=0.207) and intraoperative blood loss (P=0.450) between the two groups were not different significantly. The visual pain score in the tubeless PCNL was lower than that in tube group, no matter on the day of surgery (P=0.029), on the first day after surgery (P<0.001) or on the day of discharge (P=0.025). The postoperative hospitalization days in the tubeless PCNL were shorter than that in tube group (P<0.001).

The tubeless PCNL is safe as long as we select the patients according to 4 criteria before operation, and should pay attention to 4 key procedures and make 5 times of confirmation during operation. The postoperative pain is significantly relieved and the postoperative hospitalization days were significantly shortened in the tubeless percutaneous nephrolithotomy.

To evaluate the feasibility and safety of transmesenteric laparoscopic adrenalectomy for treatment of giant pheochromocytoma on left side.

From August 2017 to October 2018, 5 cases of giant pheochromocytoma on left side were hospitalized, the tumor diameter was 6.5-10.5 cm, with an average of 8.2 cm, 3 cases of them had a history of paroxysmal hypertension and the other 2 cases had no obvious symptoms. Transmesenteric laparoscopic adrenalectomy was performed via mesentery longitudinally at the medial mesenteric, tumor was well exposed and easy to remove. Be tender to protect the intestinal and mesenteric vessels.

All 5 procedures were well performed. The operation time was 95-180 min, with an average of 155 min. The intraoperative blood loss was 50-300 ml, with an average of 180 ml. All cases were admitted to ICU for 1-2 days after procedures. The intestinal function recovered 1-3 days after operation, and the drainage tube was removed 2-4 days after operation. The postoperative hospitalization was 8-12 days, with an average of 9.5 days. Postoperative follow-up was 4-18 months, 3 cases with preoperative paroxysmal hypertension were all relieved after operation, and no complications occurred.

For the treatment of giant pheochromocytoma on left side, transmesenteric laparoscopic adrenalectomy is feasible, safe and effective.

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 summarize 6 cases of laparoscopic retroperitoneal lymph node dissection, and to explore the techniques and lessons of the operation.

All the patients were young men. After radical operation of testicular embryonic cancer, a robot-assisted laparoscopic hypogastric lymph node dissection was performed. The contralateral lateral decubitus position + mild jackknife position for surgery, observation hole located in the belly button, 3 robot operating arm and 2 assistant hole operation range for standard dissection, all retroperitoneal lymphes were removed.

The operations were successfully completed, with about 100-250 ml of intraoperative blood loss. Patients recovered well after operation. Metastasis of tumor lymph nodes was not found by postoperative pathology.

Robotic-assisted laparoscopic retroperitoneal lymph node dissection is relatively difficult. The choice of surgical position and puncture hole is critical to the success of surgery. The precise and flexible operation of robot system can significantly benefit patients, and the protection of sympathetic trunk, abdominal aorta and its branches, vena cava and its branches is better than that of general laparoscopy.

To investigate the clinical safety and efficacy of robot combined with flexible cystoscope in the treatment of ureteropelvic junction obstruction (UPJO) complicated with secondary renal calculi, and to summarize the progress on the clinical surgery for UPJO.

Baseline data of one patient with UPJO complicated with secondary renal calculi treated by robot combined with flexible cystoscopy before operation were retrospectively analyzed. Perioperative and postoperative 1-year follow-up data were also recorded and analyzed.

The patient successfully completed the robot-assisted laparoscopic pyeloureteroplasty and pyelolithotomy. Postoperative reexamination demonstrated that the patient was well recovered without the aggravation of pelvic and ureteral hydrops.

Robot-assisted flexible cystoscopy is an efficacious treatment of UPJO complicated with secondary renal calculi, which can reduce intraoperative blood loss. It serves as a novel treatment of UPJO complicated with secondary renal calculi.

To evaluate the clinical and pathological characteristics of small-cell neuroendocrine prostate cancer.

The clinical data of one case with small-cell neuroendocrine prostate cancer were evaluated, and literature review was foused on the pathological diagnosis, clinical manifestation, imaging characteristics, treatment and prognosis for this rare disease.

The patient was male, 64 years old. In early 2014, biopsy was advised because of elevated PSA of 52.72 μg/L. The pathology for biopsy was prostate adenocarcinoma, Gleason score 3+4=7. Surgical castration was suggested. In May 2017, the patient was manifested with pelvic giant mess accompanied with intestinal obstruction, multiple bone metastasis, liver metastasis and lung metastasis. After tumor resection and colon fistula, postoperative pathology suggested small cell carcinoma. The patient was given chemotherapy with docetaxel and carboplatin after surgery and died of multiple organ failure after 2 cycles.

Prostate cancer with neuroendocrine differentiation is the most common prostate neuroendocrine tumor, however, the subtype of prostate small cell carcinoma is rare. Early surgery combined with chemotherapy is the main treatment. Cancer is usually manifested with high malignancy, rapid progression and poor prognosis.