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Objective: To investigate the effect of NBI assisted white light transurethral resection of bladder tumor (TURBT) in the treatment of bladder urothelial carcinoma and to summarize the experience of narrow band imaging (NBI) operation., Methods: Patients with bladder urothelial carcinoma were selected, and TURBT was performed after anesthesia. First of all, the bladder tumor was found and resected under white light. Then we replaced with NBI, looked for suspicious lesions and resected them, The specimens excised under white light and NBI were collected separately. The number, location and pathological results of the lesions under white light were recorded, and the residual lesions under NBI were also recorded. To evaluate the effect of NBI, the ratio of residual bladder tumor was calculated. The cases were divided into three groups according to the time sequence. The clinical data of each group were collected and the learning curve of TURBT under NBI assisted white light was observed., Results: A prospective study of 45 patients with bladder tumor from April 2018 to January 2020, including 32 males and 13 females, aged from 23 to 89 years, with an average age of 65.2 years. All the operations were successfully completed, without obvious complications after operation. Nine cases were single and 36 cases were multiple. The maximum diameter of the tumors was 0.5 to 4.0 cm, with an average of 2.2 cm. The histopathology of the resected tissue under white light was urothelial carcinoma, and 19 cases (42.2%) were pathologically positive by NBI resection. The 45 cases were divided into three groups according to the time sequence, 15 cases in each group. The true positive rate of NBI was 33.3%, 46.7% and 46.7%, respectively, and the false positive rate was 60.0%, 46.7% and 26.7%, respectively in the three groups., Conclusion: TURBT is an effective way to treat bladder urothelial cancer, NBI is an effective supplement of white light, which can increase the detection rate of bladder cancer and reduce post-operative recurrence. The NBI light source has a certain learning curve. With the increase of cases, the false-positive rate of NBI is gradually reduced. After the NBI operator has rich experience, the recognition degree of flat tumor is gradually improved under white light, and the residual rate of NBI is reduced after the removal under white light.

Objective: To analyze the clinicopathological characteristics of prostate cancer patients undertaking radical prostatectomy with single positive core biopsy, and to optimize the rational choice of therapeutic strategy., Methods: In the study, 53 patients with single positive core prostate biopsy and treated by radical prostatectomy from January 2010 to December 2018, were analyzed retrospectively. The mean age was (69.7±6.9) years (54-81 years), the mean prostate specific antigen (PSA) level was (9.70±5.24) μg/L (1.69-25.69 μg/L), and the mean prostate volume was (50.70±28.39) mL (12.41-171.92 mL). Thirty-nine out of 54 (73.6%) patients presented Gleason score with 6, 11 patients (20.8%) had Gleason score of 7 and 3 patients (5.7%) showed Gleason score ≥8. For clinical stages, 6 out of the 53 patients (11.3%) had prostate cancer in cT1, 44 cases (83.0%) had prostate cancer in cT2, and 3 cases (5.7%) in cT3.The patients were divided into subgroups according to age, preoperative PSA level, Gleason score, percentage of tumor in single needle tissue and clinical stage, and the differences of their clinicopathological characteristics were compared., Results: Postoperative Gleason score of 6, 7 and ≥8 were found in 20 cases (37.7%), 21 cases (39.6%) and 10 cases (18.9%) respectively, another 2 cases (3.8%) were pT0 prostate cancer; pathological stages of T0, T2a, T2b, T2c and T3 were found in 2 cases (3.8%), 9 cases (17.0%), 2 cases (3.8%), 29 cases (54.7%) and 11 cases (20.8%) respectively; 11 cases (20.8%) had positive surgical margin, 10 cases (18.9%) had extracapsular invasion of prostate, and 1 case (1.9%) showed seminal vesicle invasion. Forty-two cases (79.2%) had multifocal lesions and 37 cases (69.8%) presented bilateral lesion. Compared with the biopsy Gleason score, the postoperative Gleason score was downgrated in 3 cases (5.7%), unchanged in 28 cases (52.8%), and upgraded in 20 cases (37.7%), of which 2 cases (3.8%) were pT0. Compared with the clinical stage, the postoperative pathological stage decreased in 2 cases (3.8%), unchanged in 10 cases (18.9%), and upgraded in 41 cases (77.4%). According to the postoperative pathology, the patients were divided into two groups: microfocus cancer group ( n =8) and non-microfocus cancer group ( n =45). The difference between the two groups in the percentage of tumor in the single-needle tissue ≤5% was statistically significant ( P =0.014). Other parameter diffe-rences including age, prostate volume, and preoperative prostate special antigen density (PSAD) and Gleason scores were not statistically significant ( P >0.05). The method to determine the location of cancer at the apex of prostate according to biopsy results showed 41.4% (12/29) false negative rate and 50.0% (12/24) false positive rate. There was statistically significant difference between the actual cases of lymph node dissection and reserved nerve and the cases of scheme selection in theory according to the postoperative pathology ( P < 0.05)., Conclusion: The proportion of single needle cancer tissue less than or equal to 5% is a predictor of prostate microfocal cancer. 37.7% cases had pathological upgrading and 77.4% cases had pathological staging upgrading. When choosing the operation scheme, such as sexual nerve reserved, lymph node dissection and apex operation skill, it is necessary to comprehensively analyze multiple factors, such as tumor risk classification, prediction factors of nomogram, multi-parameter MRI and intraoperative situation and so on.

Objective: To evaluate the safety and efficacy of the seven-step two-lobe holmium laser enucleation of the prostate (HoLEP) technique with low power laser device, and to introduce the detailed operating procedures, key points, short-term outcomes of this modified HoLEP technique., Methods: From March 2016 to November 2017, 90 patients underwent HoLEP in Peking University Third Hospital. The patients were divided into two groups: high-power group (32 patients) were performed with traditional Gilling's three-lobe enucleation using high power (90 W) laser; Low-power group (58 patients) were performed with seven-step two-lobe enucleation using low power (40 W) laser. The main steps of the low power seven-step two-lobe HoLEP phase included: (1) The identification of the correct plane between adenoma and capsule at 5 and 7 o'clock laterally to the veru montanum; (2) The connection of the bilateral plane by making a adenoma incision at the proximal point of veru montanum; (3) The extension of the dorsal plane under the whole three lobes between adenoma and capsule towards the bladder neck; (4) The separation of the middle lobe from two lateral lobes by making two retrograde incisions separately from apex 5 and 7 o'clock towards the bladder neck; (5) The enucleation of the middle lobe adenoma by extending the dorsal plane through into the bladder; (6) The prevention of the apex mucosa by making a circle incision at the apex of the prostate; (7) The en-bloc enucleation of the two lateral lobe adenomas by extending the lateral and ventral plane between adenoma and capsule from 5 and 7 o'clock to 12 o'clock conjunction and through into the bladder., Results: The mean patient age was (66.25±5.37) years vs. (68.00±5.18) years; The mean body mass indexes were (24.13±4.06) kg/m 2 vs. (24.57±3.50) kg/m 2 ; The mean prostate specific antigen values were (3.23±2.47) μg/L vs. (6.00±6.09) μg/L; The average prostatic volumes evaluated by ultrasound was (49.03±20.63) mL vs. (67.55±36.97) mL. There was no significant difference between the two groups. Furthermore, there were no significant differences in terms of perioperative and follow up data, including operative time; enucleation efficiencies; hemoglobin decrease; blood sodium and potassiumthe change postoperatively; catheterization duration and hospital stay; the international prostate symptom scores and quality of life scores pre- and post-operatively. There was 1 transurethral resection of the prostate (TURP) conversion in high-power group and 1 transfusion in low-power group during the operations. The follow-up one month after operation showed no severe stress incontinence in both the groups, whereas 3 cases ejaculatory dysfunctions in high-power group versus 1 case in low-power group were observed; Other surgeryrelated complications included: 2 cases postoperative hemorrhage (Clavien II and Clavien IIIb) in high-power group, 2 cases postoperative temperature more than 38 °C (Clavien I) and 1 case dysuria following catheter removal (Clavien I) in low-power group., Conclusion: Low power laser device can be applied safe and effectively for HoLEP procedure using the seven-step two-lobe HoLEP technique. The outcomes comparable with high power laser HoLEP can be achieved.

Objective: To establish predictive models based on random forest and XGBoost machine learning algorithm and to investigate their value in predicting early stone-free rate (SFR) after flexible ureteroscopic lithotripsy (fURL) in patients with renal stones., Methods: The clinical data of 201 patients with renal stones who underwent fURL were retrospectively investigated. According to the stone-free standard, the patients were divided into stone-free group (SF group) and stone-residual group (SR group). We compared a number of factors including patient age, body mass index (BMI), stone number, stone volume, stone density and hydronephrosis between the two groups. For low calyceal calculi, renal anatomic parameters including infundibular angle (IPA), infundibular width (IW), infundibular length (IL) and pelvic calyceal height (PCH), would be measured. We brought above potential predictive factors into random forest and XGBoost machine learning algorithm respectively to develop two predictive models. The receiver operating characteristic curve (ROC curve) was established in order to test the predictive ability of the model. Clinical data of 71 patients were collected prospectively to validate the predictive models externally., Results: In this study, 201 fURL operations were successfully completed. The one-phase early SFR was 61.2%. We built two predictive models based on random forest and XGBoost machine learning algorithm. The predictive variables' importance scores were obtained. The area under the ROC curve (AUROC) of the two predictive models for early stone clearance status prediction was 0.77. In the study, 71 test samples were used for external validation. The results showed that the total predictive accuracy, predictive specificity and predictive sensitivity of the random forest and XGBoost models were 75.7%, 82.6%, 60.0%, and 81.4%, 87.0%, 68.0%, respectively. The first four predictive variables in importance were stone volume, mean stone density, maximal stone density and BMI in both random forest and XGBoost predictive models., Conclusion: The predictive models based on random forest and XGBoost machine learning algorithm can predict postoperative early stone status after fURL for renal stones accurately, which will facilitate preoperative evaluation and clinical decision-making. Stone volume, mean stone density, maximal stone density and BMI may be the important predictive factors affecting early SFR after fURL for renal stones.

Objective: To investigate the efficacy of intraoperative cognitive navigation on laparoscopic radical prostatectomy using 3D prostatic models created by U-shaped convolutional neural network (U-net) and reconstructed through Medical Image Interaction Tool Kit (MITK) platform., Methods: A total of 5 000 pieces of prostate cancer magnetic resonance (MR) imaging discovery sets with manual annotations were used to train a modified U-net, and a set of clinically demand-oriented, stable and efficient full convolutional neural network algorithm was constructed. The MR images were cropped and segmented automatically by using modified U-net, and the segmentation data were automatically reconstructed using MITK platform according to our own protocols. The modeling data were output as STL format, and the prostate models were simultaneously displayed on an android tablet during the operation to help achieving cognitive navigation., Results: Based on original U-net architecture, we established a modified U-net from a 201-case MR imaging training set. The network performance was tested and compared with human segmentations and other segmentation networks by using one certain testing data set. Auto segmentation of multi-structures (such as prostate, prostate tumors, seminal vesicles, rectus, neurovascular bundles and dorsal venous complex) were successfully achieved. Secondary automatic 3D reconstruction had been carried out through MITK platform. During the surgery, 3D models of prostatic area were simultaneously displayed on an android tablet, and the cognitive navigation was successfully achieved. Intra-operation organ visualization demonstrated the structural relationships among the key structures in great detail and the degree of tumor invasion was visualized directly., Conclusion: The modified U-net was able to achieve automatic segmentations of important structures of prostate area. Secondary 3D model reconstruction and demonstration could provide intraoperative visualization of vital structures of prostate area, which could help achieve cognitive fusion navigation for surgeons. The application of these techniques could finally reduce positive surgical margin rates, and may improve the efficacy and oncological outcomes of laparoscopic prostatectomy.

Objective: To assess the perioperative outcome, continence recovery and oncologic outcome of Chinese patients aged 80 years or older treated with radical prostatectomy for prostate cancer., Methods: We retrospectively evaluated the octogenarian patients who recieved biopsy for prostatic carcinoma and underwent laparoscopic radical prostatectomy from 2007 to 2016. We collected the data of clinical variables, perioperative parameters and postoperative pathological results for the octogenarian patients. We recorded and analyzed the recovery of urinary continence of the patients 3 months, 6 months and 1 year after surgery. Biochemical progression was defined as postoperative prostate specific antigen (PSA) greater than 2 μg/L for 2 times. We evaluated the non-biochemical recurrence survival rate and overall survival rate by Kaplan-Meier survival curve analysis for the patients aged 80 years or older. Multivariable COX regression analyses were used for evaluating the influence factors of biochemical recurrence after laparoscopic radical prostatectomy., Results: For all the 51 patients, the average age was (81.6±1.6) years,and prebiopsy PSA was (15.19±13.68) μg/L. There were 14 cases (27.5%), 19 cases (37.3%) and 18 cases (35.3%) for biopsy Gleason score 6, 7 and ≥8. There were 6 patients (11.8%) with clinical stage T1, 31 patients (60.8%) with clinical stage T2 and 14 patients (27.5%) with clinical stage T3. According to American Society of Anesthesiologists (ASA) classification, grade I was in 6 patients and grade II in 45 patients. All the octogenarian patients received extra-peritoneal laparoscopic radical prostatectomy. The average operation time was (189.6±69.1) min, the estimated blood volume was (169.9±163.5) mL, and 11 patients (21.6%) had perioperative complications. There were 29 cases (56.9%) and 22 cases (43.1%) staged for pT2 and pT3 based on postoperative pathological test. Of the pT3 patients, 18 (35.3%) and 4 (7.8%) were pT3a and pT3b. Eight cases (15.7%) presented Gleason score 6,21 cases (41.1%) 7 and 22 cases(43.1%) ≥8. Fourteen cases were positive surgical margin patients after surgery. Overall, the median follow up was 42 months. The continence rate of the octogenarian patients was 64.7%, 82.4% and 92.2% for 3 months, 6 months and 12 months after the surgery. Twelve cases (23.5%) had biochemical recurrence and 4 cases (7.8%) died in the follow up. There was 1 patient who died of prostate cancer progression and 3 died for other reasons. PSA (P=0.019), pT≥T3 (P=0.017) and positive surgical margin (P=0.020) were independent risk factors for biochemical recurrence of the octogenarian prostate cancer patients according to multivariable COX regression analysis., Conclusion: For well selected octogenarian prostate cancer patients, laparoscopic radical prostatectomy was a feasible treatment option. Octogenarian patients who received laparoscopic radical prostatectomy showed good oncologic outcome. PSA, pT≥T3 and positive surgical margin were independent risk factors for biochemical recurrence of octogenarian prostate cancer patients.

Objective: To summarize the experience of flexible ureteroscopic holmium laser resection in treatment of renal pelvic carcinoma and to evaluate its value in treatment of renal pelvic carcinoma., Methods: The clinical data of 6 patients with renal pelvic carcinoma treated in Peking University Third Hospital from January 2015 to January 2017 were retrospectively analyzed. The 6 patients were treated by the same experienced urologist and by flexible ureteroscopic holmium laser resection of renal pelvic tumors under general anesthesia. Regarding the intensity of the holmium laser, 10-30 W was generally used with settings of 0.5-1.5 J and 10-20 Hz. In general, a 200 μm end-firing holmium laser fiber was used. Narrow-band imaging (NBI) technique was applicated to search for tumors and check whether the excision was satisfactory. Routine "second flexible ureteroscopy" was performed after 4-6 weeks, and suspected lesions were referred for a biopy, then vaporized and cauterized. The ureteroscopy was examined every 6 months after operation, and color Doppler ultrasound, computed tomography urography (CTU) or magnetic resonance urography (MRU) were performed at the same time. The urine tumor cells were examined for 3 days before the operation, and the urine tumor markers, such as urinary nuclear matrix protein 22 (NMP22) were tested. For cases with highisk urothelial carcinoma and normal renal function, and 6 cycles of systemic adjuvant chemotherapy were performed after operation., Results: All of the cases were successfully treated. The data were as follows: the operation time 77.5 min (45-115 min), the blood loss 10 mL (5-20 mL), and hospital stay after surgery 3 days (2-5 days). After 13-34 months' followp, two patients had recurrent tumor recurrence and underwent resection operation. Two patients received systemic adjuvant chemotherapy after operation. Case 5 was histopathologically high grade urothelial carcinoma, and 6 cycles of systemic chemotherapy were given after operation. Local recurrence occurred during chemotherapy, and then endoscopic operation was performed, and no recurrence occurred in the follow-up for 12 months after reoperation. In case 6, the pathology was low grade urothelial carcinoma, but the case was multiple tumors in the right renal calyx and the lower calyx. Then 6 cycles of systemic chemotherapy were given, and no recurrence was found in the followp for 13 months., Conclusion: Transurethral flexible ureteroscopic holmium laser resection is relatively safe for the treatment of renal pelvic carcinoma. It is suitable for special cases of solitary kidney and renal dysfunction, as well as for patients with low risk urinary tract epithelial tumors, but the recurrence rate is high, and the indications need to be strictly controlled. Patients with high-risk urothelial carcinoma who underwent endoscopic resection are advised to receive systemic adjuvant gemcitabine and cisplatin (GC) regimen after surgery, in order to increase the overall survival rate. Systemic chemotherapy combined with endoscopic operation may become a new treatment for upper tract urothelial carcinoma (UTUC).

Objective: To discuss the safety and efficacy of laparoscopic ureterovesical reimplantation in the treatment of transplanted ureteral stenosis., Methods: One case of laparoscopic ureterovesicalre implantation in the treatment of ureteral stenosis after renal transplantation was reported, and related literatures was reviewed. A 54-year-old woman was admitted to our hospital with main complaint of hydronephrosis of transplanted kidney for five years after renal transplantation. Her physical examination showed slightly bulging in the transplanted kidney area without tenderness. The magnetic resonance urography (MRU) showed that the transplanted kidney and ureter were dilated obviously, with significant dilatation of renal pelvis and calyx, about 5 cm at the widest point of renal pelvis expansion, and the end of ureter was narrow, without abnormal filling defect in the ureter. The primary diagnosis was distal transplanted ureteral stenosis. After twice endoscopic ureteral dilatation by multi-endoscopic technique, there was no improvement in the hydronephrosis after the removal of the stent. After thorough preoperative preparation, laparoscopic ureterovesical reimplantation was performed under general anesthesia. Firstly, the median umbilical ligament, the lateral umbilical ligament and the peritoneal fold were cut off, and the anterior bladder space was dissociated distally. The space of left side wall of the bladder and the pubic bone was gradually dissociated, and the space of anterior bladder wall and the pubic bone was dissociated. Secondly, the right side wall of the bladder was dissociated from the head to the tail, and the surrounding structure was carefully identified to avoid injury of the ureter of the transplanted kidney. The transplanted ureter was sought between the right side of the bladder and the lower pole of the transplanted kidney. The distal end of the ureter was cut open, and the narrow section was cut off, confirming that no stenosis in the proximal ureter. The ureterocystic anastomosis was performed by Lich-Gregoir method (extra-bladder). Finally, the bladder tissue around the anastomosis site was fixed to the right pelvic wall to reduce tension., Results: The operation was completed successfully, the operation time was 210 min, the amount of bleeding was about 30 mL, and there was no surgical complication. The creatinine was stable after operation, with serum creatinine declining to 68 μmol/L, and serum creatinine 94 μmol/L before operation. The patient was discharged 5 days after operation. After follow-up of 3 months, KUB indicated that the position of ureteral stent was good and the function of renal transplantation was stable., Conclusion: Laparoscopic ureterovesical reimplantation is a safe and effective treatment for ureteral ureteral stricture after renal transplantation. Compared with open surgery, laparoscopic surgery has less impact on renal renal allograft, with faster recovery, less bleeding, fewer complications, less postoperative pain and minimally invasive wound. This surgical procedure is difficult and requires an experienced urologist with high laparoscopic skills to perform.

Objective: To assess the relationship between recovery of urinary continence after laparoscopic radical prostatectomy (LRP) and prostatic volume (PV) and intravesical prostatic protrusion length (IPPL) on preoperative magnetic resonance imaging (MRI)., Methods: 88 patients with pathologic confirmed prostate carcinoma who were underwent LRP were included in this study. MRI examination was performed in 1 week before the biopsy. The patients were divided into two groups according to PV (<50 mL, ≥50 mL) on preoperative MRI. The patients were divided into two groups according to IPPL (<5 mm, ≥5 mm), IPPL was measured on MRI as the vertical distance from the tip of the protruding prostate to the base of the urinary bladder. After surgery we recorded and analyzed recovery of urinary continence of the patients for one year., Results: All the 88 patients received extra-peritoneal LRP successfully. The average operation time was (155±67) min, and the estimated blood volume was (145±159) mL. There was a significant difference between group PV<50 mL and ≥50 mL in the operation time (P=0.045). All the patients who underwent MRI preoperatively showed that their mean PV was (44.54±26.58) mL and mean IPPL was (5.2±5.7) mm. The continence rate for all the patients after LRP was 53.4%, 84.1% and 94.3% in their follow-up of 3, 6 and 12 months. Three months after LRP, the continence rate for group PV<50 mL and ≥50 mL were 61.5% and 30.4%, which were completely continent (P=0.010). Six or twelve months after surgery, the continence rate was 87.7% and 73.9% (P=0.120), 96.9% and 87.0% (P=0.076) for group PV<50 mL and ≥50 mL separately. Three months after LRP, the continence rate for group IPPL<5 mm and ≥5 mm were 66.1% and 31.3%, which were completely continent (P=0.002). Six months after surgery, the continence rate was 92.6% and 68.8% (P=0.003), and one year after surgery, the continence rate was 98.2% and 87.5% for group IPPL<5 mm and ≥5 mm separately (P=0.037). There was a significant difference between group PV<50 mL and ≥50 mL in the urinary continence curve (P=0.017), and the same significant difference between group IPPL<5 mm and ≥5 mm (P=0.001)., Conclusion: The PV and IPPL on preoperative MRI were associated with significantly slower return of urinary continence, especially for early recovery (3 months) of continence after LRP.

Objective: To analyze the potential perioperative risk factors that affect the development of urosepsis following percutaneous nephrolithotomy (PCNL) for upper urinary tract calculi with a regression model, and to develop a nomogram for predicting the probability of postoperative urosepsis after PCNL according to the identified independent risk factors., Methods: We retrospectively analyzed the clinical data from consecutive 405 cases of upper urinary tract calculi treated by one-phase PCNL between January 2013 and December 2016 in our clinical department. According to whether the patients developed urosepsis or not after the surgery, the patients were divided into two groups. Perioperative risk factors that could potentially contribute to urosepsis were compared between the two groups. By a Logistic regression model, univariate and multivariate statistical analyses were carried out for the occurrence of postoperative urosepsis, to identify the independent risk factors affecting the development of postoperative urosepsis. From this model, a nomogram was built based on regression coefficients., Results: The PCNL procedures of the 405 cases were performed successfully, and there were 32 cases that developed urosepsis after the PCNL, and the incidence of urosepsis was 7.9% (32/405). A multivariate Logistic regression model was built, excluding the factors with values of P>0.05 in the univariate analysis. Multivariable Logistic regression analysis identified the following factors as independent risk factors for urosepsis after PCNL: diabetes mellitus history (OR=4.511, P=0.001), larger stone burden (OR=2.588, P=0.043), longer operation time (OR=2.353, P=0.036), increased irrigation rate (OR=5.862, P<0.001), and infectious stone composition (OR=2.677, P=0.036). The nomogram based on these results was well fitted to predict a probability, and the concordance index (C-index) was 0.834 in the nomogram model sample and 0.802 in the validation sample., Conclusion: Diabetes mellitus history, higher stone burden, longer operation time, increased intraoperative irrigation rate, and infectious stone composition are identified as independent risk factors to affect the development of urosepsis after one-phase percutaneous nephrolithotomy for upper urinary tract calculi. A nomogram based on these perioperative clinical independent risk factors for urosepsis could be used to predict the risk of urosepsis following PCNL.

Objective: To evaluate the efficacy and safety of flexible ureteroscopic holmium laser lithotripsy in treating calyceal diverticular calculi with stenotic infundibulum and to present our initial experience., Methods: From Nov. 2012 to Nov. 2014, 10 patients with stone-bearing calyceal diverticulum and stenotic infundibulum underwent flexible ureteroscopic holmium laser lithotripsy in our hospital, including 3 female patients and 7 male patients with an average age of 36.9 years (range: 20 to 62 years). There were 6 patients with right side while 4 patients with left side calyceal diverticular calculi. The average cumulative stone size was (1.33±0.43) cm. Five patients underwent extracorporeal shock wave lithotripsy (ESWL) before hospital admission but no stone was discharged. All the patients received intravenous urography (IVU) and CT-urography (CTU) preoperatively and underwent double-J stents placement 2 weeks before operations. A digital-fiber flexible ureteroscopy and 200 μm holmium laser fiber were used for treatment. Surgeries began with routine flexible ureteroscopy and methylene blue injection was used to identify the small ostium of infundibulum. Then infundibulectomy followed by lithotripsy was performed. All the patients receive double-J stents placement and traditional Chinese medicine for 1 to 3 months after operations. The stone clearance was estimated by kidney ureter bladder (KUB) within 3 months' follow up., Results: The locations of calyceal diverticulum were upper pole in 7 patients, and interpolar regions in 4 patients. The average operation time was (123.7±59.6) min, and the average estimated blood loss was (29.3±32.1) mL. Successful flexible ureteroscopic holmium laser infundibulectomies were performed in all the 10 patients. Success rate was 100%. The stone clearance rates for 1 and 3 months after surgery were 50.0% and 80.0%, respectively, which were observed by KUB follow-up. Two patients had serious post-operative fever (>38.0 °C) in coexistence with chills. The mobidity of urosepsis was 20.0%. No major complications were identified., Conclusion: In selected patients, calyceal diverticular calculi with stenotic infundibulum can be treated safely and efficiently with flexible ureteroscopic homium laser lithotripsy. CTU and IVU should be completed preoperatively for calyceal diverticulum location and technique difficulty prediction. Retrograde methylene blue injection can be used to identify the ostium during surgery. And prolonged post-operation stone clearance was observed.

Objective: To evaluate the method and efficacy of endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach for ureteral obstruction after kidney transplantation., Methods: Eight cases were analyzed retrospectively who received endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach when they had been diagnosed with ureteral obstruction in the transplant kidney from February 2007 to March 2013 in Department of Urology, Peking University Third Hospital. The cases included three males and five females, with the average age being 44 years (30-64 years). The interval between ureteral obstruction and kidney transplantation ranged from one month to 12 months. Four cases presented with increased serum creatine, two with anuria and two with urinary leakage. The stricture site was located in ureter terminal part in seven cases, and middle part in 1 case. In three cases, percutaneous nephrostomy were carried out immediately while endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach were carried out later. The remaining five cases were treated simultaneously., Results: The average serum creatine decreased from (237±43) μmol/L to (121±29) μmol/L (P<0.05) after the therapy. No perioperative complications occurred. Two urinary fistula healed. Six cases were treated successfully with two cases that failed followed by percutaneous nephrostomy. The ureteral obstruction recurred in one case after six months with recurrence rate of 17% (1/6)., Conclusion: Endoscopic therapy combined with antegrade percutaneous approach and retrograde transurethral approach is an effective therapeutic approach to treat ureteral obstruction in transplant kidney which shows good clinical results.

Objective: To evaluate the feasibility, efficacy and safety of laparoscopic partial nephrectomy for complex renal cystic lesions., Methods: A retrospective cohort study was conducted on the clinical data of 27 patients with complex renal cystic lesions treated by laparoscopic partial nephrectomy from May 2008 to April 2011 in Peking University Third Hospital. According to the Bosniak classification, 7 cases were lesions of grade IIF, 11 of grade III, and 9 of grade IV. The mean diameter of cystic lesions was (3.58±0.75) cm, and 4 lesions were larger than 4.0 cm., Results: All procedures were performed through retroperitoneal approach and successful. The mean operative time was (123.1±16.8) min, ranging from 100 min to 160 min, and the mean renal warm ischemia time was (29.7±3.5) min, ranging from 25 min to 40 min. Blood loss in the operations was from 50 mL to 110 mL, the mean being (75.5±21.8) mL. The postoperative hospital stay was 4 to 6 days, and the mean was (5.11±0.85) days. Postoperative pathological results included 10 simple renal cysts (37.0%), 2 cases of adult cystic nephroma (7.4%), 1 mixed epithelial and stromal tumor (3.7%), 13 cases of renal cell carcinoma with cystic change (48.1%), and 1 multilocular cystic renal cell carcinoma (3.7%). The results showed that 14.3% of cystic lesions of grade IIF, 45.5% of grade III and 88.9% of grade IV were malignant. In the follow-up ranging from 12 to 48 months (median 24 months), there was no case of recurrence., Conclusion: The differentiation between benign and malignant renal cystic lesions before surgery remains difficult. According to the Bosniak classification, radiological diagnostic findings are standardized, but still limited in the accuracy to determine the dignity of pathological entity. Laparoscopic partial nephrectomy is feasible to treat complex renal cystic lesions, and is a safe and effective minimally invasive option.

Objective: To evaluate urinary continence outcomes after laparoscopic radical prostatectomy (LRP), and explore the learning curve for continence., Methods: Between May 2006 and May 2011, 200 consecutive patients with clinically localized prostate cancer underwent LRP in Peking University Third Hospital, of whom 160 were performed by a single surgeon and followed up successfully. The average age was (71.9±5.5) years (their age range: 56 to 85 years). All the patients were continent before operation. Of these patients, 11 had undergone previous transurethral resection of the prostate (TURP) and the other 149 were diagnosed by transrectal prostate biopsy. No metastasis was found before surgery. The data about the patients and the operations were recorded. The time from operation till urinary continence was obtained and accessed by interviews. Continence was defined as the use of no pad and no urinary leakage or loss of a few drops occasionally. The patients were divided into 4 equal groups in the 40 consecutive series to determine whether continence was statistically different in group A (1-40) as compared with the other groups., Results: All the operations were performed laparoscopically without any conversion to open surgery. The mean operative duration was (230±57) min (ranging from 110 to 493 min), the median estimated blood loss was 200 mL (ranging from 30 to 1 200 mL), 12 patients (7.5%) received blood transfusions intraoperatively, and the average hospital stay after surgery was (11.8±7.9) d (ranging from 5 to 60 days). The distribution of pathologic stages was as follows: T2a 20%, T2b 16.9%, T2c 40%, T3a 15%, T3b 5.6% and T4 2.5%. The overall positive surgical margin (PSM) rate was 32.5%. The overall continence rates (no pad) were 14.4% after 1 month, 48.8% after 3 months, 77.5% after 6 months and 86.3% after 12 months. At the end of the follow-up, 21 patients (13.1%) were still incontinent . There was a significant difference in continence between the early (Group A) and later groups (P<0.05)., Conclusion: Continence results after LRP were encouraging, which were comparable to the results in previously published open series. Continence could be improved with increasing surgical experience, and it takes 40-50 cases to reach a plateau for surgeons who have some experiences of laparoscopic operations.

Objective: To present the preliminary experience of the operative procedure and clinical outcomes of retroperitoneal laparoscopic nephroureterectomy (RPLNU) with a midline lower abdominal transperitoneal incision for native upper urinary tract transitional cell carcinoma (UUT-TCC) ipsilateral to a transplanted kidney., Methods: In the study, 15 renal recipients with native UUT-TCC ipsilateral to a transplanted kidney were operated on with RPLNU via a midline lower abdominal transperitoneal incision between November 2005 and January 2009. Retroperitoneal laparoscopic nephrectomy was performed first and followed by cystoscopic excision of ipsilateral ureteral orifice with bladder cuff. A 6-8 cm midline lower abdominal incision was made. The distal ureter was dissected transperitoneally into the intramural segment and extracted completely. The intact specimen was removed manually via the same incision. The cystostomy was generally sutured., Results: The mean operation time was 253 minutes. The mean estimated blood loss was 245 mL. Three patients needed blood transfusion. No open conversion was required during the retroperitoneoscopic nephrectomy. Two of the patients suffered from minor complications. The pathological findings confirmed UUT-TCC in all the patients with 9 of the pelvises and 9 of the ureters. Five of the patients were involved with bladder TCC. With the mean follow-up of 35 months, none of them had retroperitoneal recurrence or distant metastasis, 2 of the 5 patients with bladder TCC had recurrence in bladder and 4 had contralateral native UUT-TCC after the first unilateral nephroureterectomy., Conclusion: RPLNU with a midline lower abdominal transperitoneal incision may be a safe and feasible alternative for native UUT-TCC ipsilateral to a transplanted kidney with satisfactory oncologic outcomes.

Objective: To evaluate the efficacy and safety of transumbilical single-port laparoscopic radical nephrectomy., Methods: The clinical data of laparoscopic radical nephrectomy performed from June 2010 to October 2010 in Peking University Third Hospital were analyzed retrospectively. In the study, 10 patients underwent transumbilical single-port laparoscopic radical nephrectomy (LESS) and 15 received retroperitoneal laparoscopic radical nephrectomy. The data on general presentation, tumor size, tumor location, operative time, blood loss, complications, Visual Analog Pain Scale (VAPS), postoperative hospital stay, pathological results were collected to compare between the two groups. Our homemade single-site equipment was used in the LESS approach and the kidney was dissociated after being cut off the renal vessel and extracted through the umbilical incision. The retroperitoneal approach followed the standard surgical procedures, and the specimens were removed from the extended incision., Results: All the procedures were completed without conversion to open radical nephrectomy. Compared with traditional laparoscopic surgery, the operative time (P=0.001) and VAPS (P=0.002) showed significant difference in LESS group,and no difference was noted in other factors (P>0.05). There was no secondary bleeding, wound infection, intestinal obstruction, incision hernia and other severe postoperative complications. The follow-up of 6 to 10 months showed no local recurrence., Conclusion: Transumbilical single-port laparoscopic radical nephrectomy is feasible, effective and safe. It gives a more mini-invasive and cosmetic option for young or female patients.

Objective: To investigate whether there is a protective mechanism in exogenous magnesium ions supplement in renal ischemia reperfusion injury(IRI ), and to study the expression of heat shock protein 70 (HSP70) and HSP70-mRNA in the reperfusion injury., Methods: A total of 90 male Japanese white rabbits (1.8-2.0 kg) were divided into three groups: ischemia reperfusion group (I-R), MgSO4 pretreatment group and sham operation group. The right kidney was cut through median abdominal incision to make solitary kidney model. The left renal artery was blocked for 1 h in I-R group and MgSO₄ group. 2.5% MgSO₄ 1 mL/(kg×h) was given through ear vein before the artery was blocked and during the blockeage in the MgSO₄ group. the kidney cortex tissue was taken 1, 2, 4, 24, 48 and 72 h after reperfusion. Immunohistochemical examination was used to determine the HSP70 expression. A modified quantitative Real time-PCR was used to quantitate HSP70-mRNA in the three groups. Pathological examination was also used to confirm the results., Results: Real time-PCR showed that HSP70-mRNA began to increase at the end of 1 h, and reached the peak at the end of 2 h in both I-R and MgSO₄ groups, but expression in I-R group which was remarkably higher than that in the MgSO₄ group at the end of 2 h and 4 h ( P<0.05). HSP70-mRNA levels decreased rapidly at the end of 24 h. In I-R group, moderate HSP70 expression could be seen in the proximal tubules during immunohistochemical examination after reperfusion for 24 h and 48 h. By contrast, there was weak HSP70 expression in the MgSO₄ group 24 h and negative 48 h after reperfusion. Epithelial shedding, border brush, inflammatory cell infiltration and protein casts were serious after 24 to 48 h reperfusion, while only slight tubular cell shedding and necrosis could be found in the MgSO₄ group at the matched time., Conclusion: Magnesium supplement can significantly relieve the renal ischemia reperfusion injury. It can inhibit the upregulated expression of HSP70 and HSP70-mRNA in vivo, which demonstrates that the expression of HSP70 is not necessary in the protective mechanism.