Abstract:Objective:To describe and evaluate the safety and feasibilityof a novel classification named"301 classification"and its corresponding surgical technique in the treatment of renal tumor and venous extension. Methods:From June 2013 to August 2017,a total of 100 cases of renal neoplasm and venous tumor thrombus un-derwent surgical treatment in Chinese PLA General Hospital.A novel classification named"301 classification"was established to make decision of surgical strategy.Renal vein tumor thrombus on the right side was classified as lev-el 0,and renal vein tumor thrombus on the left side as level 0a or 0b depending on whether the thrombus exceeds the superior mesenteric artery or not.The IVC thrombi were classified into 4 levels:Level Ⅰ referred to the thrombus in the IVC but below the first porta hepatis;Level Ⅱ referred to the retrohepatic thrombus between the first and the second porta hepatis;Level Ⅲ referred to the suprahepatic thrombus at the level or above the hepatic vein but below the diaphragm;Level Ⅳ referred to the thrombus exceeding the diaphragm.Surgical strategies in-clude the necessity of angioembolization of renal artery,position changing,liver mobilization,liver hilum vessels clamp,and veno-venous or cardiopulmonary bypass,which depend on the level of venous tumor thrombus.The perioperative data such as operation time,estimated blood loss,hospital stay and complications were retrospec-tively analyzed.Results:A total of 100 patients were analyzed,including 77 males and 23 females.The median age was 56 years (23-81 years).Grouped by the noval classification,6 cases were classified as level 0b,40 cases as levels 0 or 0a,32 cases as Level Ⅰ,15 cases as Level Ⅱ,6 cases as Level Ⅲ,and only one case of Level Ⅳ.One hundred operations were successfully performed using the strategies divided by"301 classification",which include-ed 68 cases given robotic surgery,19 cases given laparoscopic surgery and 13 cases given open surgery.There was no intraoperative pulmonary embolism,however,there was one case of intestinal injury and 2 cases of spleen inju-ry.The median operation time was 164 min (range,43 to 465 min)for all patients,109.5 min (range,43-324 min)for level 0/0a,196 min (range,120-348 min)for level 0b,170 min (range,76-422 min)for level Ⅰ,240 min (range,130-360 min)for level Ⅱ,337 min (range,255-465 min)for level Ⅲ,and 336 min for level Ⅳ,re-spectively.The median estimated blood loss was 400 Ml (range,20-7000 Ml),100 Ml (range,20-2000 Ml) for 0a,450 Ml (range,100-3000 Ml)for level 0b,425 Ml (range,20-4500 Ml)for level Ⅰ,1200 Ml (range,100-4000 Ml)for level Ⅱ,2600 Ml (range,500-7000 Ml)for level Ⅲ,3000 Ml for level Ⅳ,re-spectively.There was significant difference in operation time and estimated blood loss among levels (P <0.001). All the patients recovered well after discharge,and the median postoperative hospital stay was 7 days (range,3-30 days).The common tumor type was clear cell renal cell carcinoma (79 cases),followed by papillary renal cell car-cinoma (9 cases)and others (12 cases).Conclusions:The "301 classification" and its corresponding strategies were established based on the experience of Chinese PLA General Hospital and it is feasible and safe for surgical treatment of renal neoplasm and venous tumor thrombus.However,more cases from multicenters are needed to confirm the conclusion.

Abstract:Objective:To explore the Clinical practice of minimally invasive percutaneous holmium laser lithotripsy in the treatment of complicated renal calculi.Methods:Clinical information data of 103 cases of complex renal calculi patients who underwent minimally invasive percutaneous nephrolithotomy holmium laser lithotripsy from August 2007 to February 2016 were analysed,and the clinical effect of the surgical therapy were explored.Results:The clinic data showed the stones in 65 patients (63.11%) was removed completely in the frist time,28 patients (27.18%) get stone free in stage two,and the urinary calculi remained after surgical therapy in 10 patients(9.71%) who got drug treatment and ESWL.Conclusions:The use of minimally invasive percutaneous endoscopic holmium laser lithotripsy in the treatment of complex nephrolithiasis has a good therapeutic effect and security,can greatly improve the stone free rate.

Abstract:Objective:To investigate the clinical effects,safety and economical efficiency differences in tran-surethral ureteroscope lithotripsy (URL),minimally invasive percutaneous nephrolithotomy (MPCNL)and retro-peritoneoscopic ureterolithotomy (RLU)in the treatment of complex upper ureteral calculi.Methods:150 patients with complex upper ureteral calculi were chosen in the period from June 2012 to June 2015 in our hospital and ran-domly divided into three groups:group A (n=50)receiving URL,group B (n=50)receiving MPCNL,and group C (n=50)given RLU.The perioperative clinical indicators,once disposable stone clearance rate,the post-operative complication incidence and the total treatment expenses among three groups were compared.Results:The operation time in group C was significantly longer than in group A and group B (P<0.05).The blood loss in group B was significantly less than in group A and group C (P<0.05).The once stone clearance rate in group B and group C was significantly higher than in group A (P<0.05).The postoperative complication incidence in group C was significantly lower than in group A and group B (P<0.05).The total treatment expenses in group C was significantly lower than in group A and group B (P<0.05).Conclusions:Compared with URL and MPCNL, RLU in the treatment of complex upper ureteral calculi can efficiently improve stone clearance effects,reduce the risk of postoperative complications and be helpful to lessen the financial burden.

Abstract:Objective:To compare the complication rate of transrectal ultrasound(TRUS)guided prostate bi-opsies with transperineal approach and transrectal approach,to find out the causes and explore the prevention and treatment methods,provide evidence for clinicians to select the appropriate biopsy approach under different condi-tions.Methods:Statistical analysis was performed on a total of 609 patients who underwent prostate biopsy in 307th Hospital of PLA and Air Force General Hospital of PLA from 2010 to 2016.All patients were divided into transperineal group and transrectal group,and the incidence of complications was analyZed.Results:There was no significant difference in the incidence of hematuria and pain between the two groups.The incidence of total compli-cations,serious complications,hematocheZia,fever and sepsis in the transrectal group was significantly higher than that in the transperineal group.Conclusions:The transrectal approach is more convenient and time saving than the perineal approach,and the perineal approach is safer than the transrectal approach.

Abstract:Objective: To evaluate the efficacy of simultaneous transurethral resection of bladder and prostate (TURBT+TURP) in the treatment of non-muscle invasive bladder cancer (NMIBC) with benign prostate hyperplasia (BPH) for the aged patients.Methods: The clinical data of 89 elderly patients with NMIBC and BPH were analyzed retrospectively.Forty-eight patients who underwent TURBT+TURP composed the combination group, and 41 patients who underwent TURP composed the control group.The surgery situation and prognosis were compared.Results: The operative time, blood loss and hospital stays in the combination group were obviously increased as compared with those in control group (P<0.01).After 1 year of operation, both the International Prostate Symptom Score (IPSS) and residual urine volume (PVR) value in the combination group were lower, and the maximal flow was higher than in the control group (P<0.01).After 2 years of operation, the recurrent rate was 2.1% and 17.1% respectively in the combination group and control group and the difference was significant (χ2=6.073, P<0.05).In the combination group, the incidence of urethral stricture was 2.1%, which was lower than that in the control group (17.1%) (χ2=6.073, P<0.01).Conclusions: Simultaneous TURBT and TURP can reduce the postoperative recurrence, relieve difficulty in voiding, decrease incidence of urethral stricture for aged patients with NMIBC and BPH.

Abstract:Objective:To compare the safety and clinical effects of the flexible ureteroscope lithotripsy vs.per-cutaneous nephrolithotomy lithotripsy for the management of renal stones 2 cm or greater.Methods:We retro-spectively analyzed the records of 60 patients who underwent percutaneous nephrolithotomy or flexible ureterosco-py lithotripsy in our hospital from March 2012 to March 2015.In this study 30 patients were given flexible uret-eroscopy lithotripsy,and 30 patients were subjected to percutaneous nephrolithotomy treatment.The operative time,stone clearance rate,hospitalization time and complication rate were compared.The intragroup comparison was done by t-test,and a probability (P)value of less than 0.05 was taken to indicate statistical significance.Re-sults:In flexible ureteroscopy group and percutaneous nephrolithotomy group the stone diameter was (2.0±0.5) and (2.1±0.4)cm (P>0.05),operative time was (58.4±7.7)min and (39.4±7.5 )min,hospitalization time was (7.3±1.6)days and (14.6±1.5)days,and the complication rate was 10.0% and 6.7% respectively.Con-clusions:In comparison to percutaneous nephrolithotomy lithotripsy,the flexible ureteroscopy lithotripsy enjoys a minimal trauma and low complication rate.The flexible ureteroscopy lithotripsy is an alternative treatment in the management of renal stones 2 cm or greater.

Abstract:The incidence of renal cell carcinoma is gradually increased in China,and it has become a kind of tumors with the 10th cancer incidence in men at 2008.Complex renal tumors are defined as a kind of localized tumors with such clinical and biological characteristics as RENAL score ≥7,anatomic or functional solitary kidney,and without local or remote metastasis.Partial nephrectomy (PN) for the complex renal tumors is great challenges for the urology surgery.Recently,some important progresses have been made on the operational therapy of complex renal tumors,along with the developments on the surgery techniques,equipments,and ancillaries.RN surgeries such as open PN,laparoscopic PN,and robot-assisted PN,have gradually replaced radical nephrectomy,and have effectively improved the quality of life and overall survival of patients.In this paper,progress on the methods,safety,and effectiveness in the PN treatment of complex renal tumors was reviewed.

Abstract:Partial nephrectomy can provide long-term benefit for patients with T1-stage kidney cancer,and the effect of tumor control is the same as that of radical nephrectomy.Therefore,partial nephrectomy is more applied in the treatment of kidney cancer.With the superior performance of the robotic surgical system,robot-assisted laparoscopic partial nephrectomy (RAPN)has obvious advantages in nephron-sparing surgery and its application prospect is broad.RAPN will be the mainstream of the nephron-sparing surgery for kidney cancer in the future.

Abstract:Objective:To evaluate the therapeutic effect of 12 o'clock position urethral mucosa preservation in transurethral enucleation of the prostate for treatment of patients with benign prostate hyperplasia.Methods:354 patients with benign prostate hyperplasia underwent transurethral enucleation of the prostate.196 patients were given complete enucleation of the prostate and urethral mucosa,and 158 patients were subjected to preservation of 12 o'clock position urethral mucosa and anterior fibromuscular stroma during the operation.The patients were fol-lowed up for 6 months to evaluate the peak flow rate,post-void residual urine volume,and International Prostate Symptom Score before and after operation,respectively.Incontinence rate was evaluated weekly from 24 h to 6 months after surgery.Results:The symptom of lower urinary tract obstruction was improved obviously after sur-gery in both groups.There were no significant differences in the peak flow rate,post-void residual urine volume, and International Prostate Symptom Score between two groups during the follow-up period.The incontinence rate was lower in patients with preservation of 12 o'clock position urethral mucosa during the operation than in those undergoing complete enucleation of the prostate and urethral mucosa.Conclusions:Preservation of 12 o'clock posi-tion urethral mucosa in transurethral enucleation of the prostate can alleviate the low tract obstruction symptom and reduce incontinence rate in patients with benign prostate hyperplasia.

Abstract:Objective:To evaluate the clinical effect of transurethral resection (TUR)of bladder tumor combined with internal iliac artery chemotherapy with or without intravesical instillation therapy for muscle invasive bladder cancer (MI-BC).Methods:Seventy-one patients with MIBC were selected and treated with TUR of bladder tumor combined with in-travesical instillation therapy,with or without internal iliac artery chemotherapy (chemotherapy regimen:gemcitabine and cisplatin,GC)between February 2007 to June 2014.The bladder preservation and survival rate as well as cancer specific survival rate (CSS)and overall survival rate (OS)of the two groups were compared.Results:Seventy-one patients were followed up for 18-100 months with an average of 59 months.The two-year bladder preserved rate in TUR+GC group and TUR group was 92.9% and 79.3%,respectively (P<0.05).The one-year DFS in TUR+GC group and TUR group was 83.3% and 58.6%,and the 2-year DFS was 78.6% and 62.1% for 2 years,respectively (P<0.05).The 2-year cancer CSS in TUR+GC group and TUR group was 92.9% and 82.8%,respectively (P>0.05).The 2-year OS in TUR+GC group and TUR group was 88.1% and 82.8%,respectively (P>0.05).Conclusions:TURBT and intra-vesical instillation therapy combine with internal iliac artery chemotherapy for MIBC may have better outcome at recur-rence-free survival,bladder preserved rate,DFS than the treatment without internal iliac artery chemotherapy,and there was no difference in OS and CSS.