Abstract:Objective:To evaluate the efficacy and feasibility of the robot-assisted laparoscopic pyeloplasty (RALP) combined with flexible ureteroscope lithtripsy (f-URL) for treatment of ureteropelvic junction obstruction (UPJO) with renal calculi.Methods:We retrospectively reviewed the records of 12 patients who underwent RALP and f-URL for UPJO with renal calculi from March 2013 to September 2015.Three cases had solitary stones located at the lower calyx,and the other two had multiple stones.Of 12 cases of UPJO,there were 7 cases in the right kidney,and 5 cases in the left kidney.Seven cases had solitary stones located at the lower calyx,and the rest 5 cases had multiple stones.B-ultrasound examination showed that severe hydronephrosis occurred in 4 cases,intermediate in 5 cases,and mild in 3 cases.Results:The operation was successful in all the 12 patients with no severe complications.The average total operation time was (128.6±26.3) min and the average f-URL time was (30.2±13.5) min.The average blood loss was (37.1±9.7) mL and the average hospital stay length was (6.2±1.5) days.No conversions to open surgery were required.During the postoperative follow-up period of 12 to 42 months,the stone-free rate was 100%.Lumbago disappeared in 12 cases and there was no stricture at UPJ by retrograde pyelography.Hydronephrosis was remitted (among 4 cases with severe hydronephrosis,hydrops remitted from severe to interm ediate in 1 and to mild in 3;among 5 cases with intermediate hydronephrosis,hydrops remitted from interm ediate to mild in 2 and 3 had resolution:3 cases with mild hydronephrosis had resolution).Conclusions:RALP combined with f-URL is effective and feasible for treatment of UPJO with renal calculi.

Abstract:Objective:To evaluate the clinical efficacy and safety of high selective laparoscopic ligation of sper-matic vein for the treatment of varicocele.Methods:A retrospective analysis was performed on totally 60 cases of primary varicocele above grade Ⅱ in our hospital.Group A (n =30)underwent high selective laparoscopic ligation of spermatic vein,while spermatic arteries were preserved.Group B (n =30)underwent laparoscopic cluster ligation of spermatic vein.The operation time,postoperative complications,recurrence rate,and sperm quality improvement were analyzed statistically.Results:All 60 cases operated successfully,and were followed up for 6 months after op-eration.The operation time of two groups was (41.3±9.8)min and (25.7±8.1)min respectively.The incidence of postoperative complications in two groups was 3.3% (1/30)and 13.3% (4/30)respectively.The improvement of semen quality in 6 months after operation in two groups was 73.3% (22/30)and 60% (18/30),respectively.There were significant differences in above indexes between two groups (P <0.05).The recurrence rate of two groups was 6.7% (2/30)and 3.3% (1/30)respectively,and there was no significant difference between two groups (P >0.05).Conclusions:High selective laparoscopic ligation of spermatic vein with spermatic artery preservation requires shorter operation time,has low incidence of postoperative complications and high improvement rate of semen quali-ty,while leading to no more recurrence rate,and is worth to be extended in clinics.

Abstract:Objective:To investigate the effect of super mini percutaneous nephrolithotomy(SMP)combined with flexible ureteroscopic lithotripsy(FURL)in the treatment of complex renal calculus and its effects on renal he-modynamics and stress response.Methods:A total of 225 patients with complicated renal calculus in our hospital from January 2019 to August 2021 were selected and divided into three groups according to the random number table method,with 75 cases in each group.GroupAwas treated with SMP combined with FURL,group B was treated with SMP,and group C was treated with FURL.The rate of stone removal,operation,postoperative,renal hemo-dynamic indicators[end-diastolic flow velocity(Vmin)of renal segmental artery,peak systolic flow velocity(Vmax),resistance index(RI)],stress reaction indicators[serum cortisol(Cor),norepinephrine(NE),adreno-corticotropic hormone(ACTH)]before and after operation,quality of sexual life and rate of complications were com-pared between the three groups.Results:Thestone removal rate of group A was higher than that of group B and C,and the stone residual rate was lower than that of group B and C(P＜0.05).There were no significant defferences in the stone removal and residual rate between that of group B and C(P＞0.05).Compared with group C,Groups A and B had higher intra-operative hemorrhagic volume,postoperative first off-bed time,and hospital staywith statistical significance(P<0.05).Compared with preoperative,the three groups had lower Vmin and Vmax postoperative 1d,group A and B was lower than that of group C,higher RI,serum Cor,NE,and ACTH postoperative1d,sexual life scoreof patient and spousepostoperative three months,group A and B were higher than that of group C with statistical significance(P<0.05).There was no significant differences in the rate of complications between the three groups(P>0.05).Conclusion:The combination of SMP and FURL for complex renal calculus significantly improves stone removal rate,reduces stone residual rate,and improves postoperative quality ofsexual life more significantly,and does not increase the impact on renal hemodynamics,stress response,or risk of complications compared with SMP.

Abstract:To study the efficacy and safety of 1470 nm diode laser for the treatment of benign prostat-ichyperplasia (BPH).Methods :A total of 87 patients under went vaporization of the prostate using 1470 nm diode laser .The mean operative time ,blood loss ,the international prostate symptom score (IPSS),the score of life quali-ty ,bladder resi dual urine volume ,flow rate and ind welling catheterizati on time were recorded and analyzed .Results :All procedures were successfully performed by one operation .The operation time was (72 ±31 )min ,and blood loss (23 ±11)mL .No case needed blood transfusion ,and there was no TURP-related syndro me .The meanind welling catheterizati on time was (35 ±20 )h .Eighty-seven cases were followed up for 3 to 12 months .The IPSS was de-creased from preoperative (27.3±2.4)to (5.8±1.6).The QOL was decreased from preoperative (4.8 ±1.1 )to (1.7 ±0.4 ).The maximum flow rate was increased from preoperative (6.3 ±3.2 )mL/s to (19.8 ±2.1 )mL/s .The residualurine volume was decreased from preoperative (86.7 ±1 39.5 )mL to (29.3 ±5.1 )mL .All the differences were statistically significant (P <0.05 ).Conclusions :1470nm diode laser is safe ,efficacious and mini mally invasive for the patients of BPH .

Abstract:Objective:To explore the influence of pirarubicin intravesical therapy on serum soluble intercellular adhesion molecule-1 (sICAM-1), vascular endothelial growth factor (VEGF) and matrix metalloproteinase-9 (MMP-9) in patients with superficial bladder cancer (SBC).Methods:132 patients with SBC undergoing transurethral resection of bladder tumor (TURBT) were divided into control group and observation group according to the treatments, with 66 cases in each group.The patients in control group received mitomycin intravesical therapy after TURBT and those in observation group received pirarubicin intravesical therapy.The recurrence rate within 2 years after surgery and complication during treatment were observed in two groups.The changes in serum sICAM-1, VEGF and MMP-9 were compared between two groups 6 months after surgery.Results:The recurrence rate within 2 years after surgery in observation group was significantly lower than in control group, while the recurrence rate during 6 to 12 months after surgery and ectopic recurrence rate in observation group were significantly lower than in control group (P＜0.05).The time of recurrence in observation group was significantly later than in control group (P ＜0.05).The serum sICAM-1, VEGF and MMP-9 levels were significantly reduced in two groups 6 months after surgery as compared with those before operation and those indexes in observation group were lower than in control group (P＜0.05).There was no significant difference in complications between two groups during intravesical therapy (P＞0.05).Conclusions:Intravesicaltherapy of pirarubicin can effectively reduce serum sICAM-1, VEGF and MMP-9 levels in patients with SBC, and inhibit the recurrence of bladder cancer, and has good application value.

Abstract:Objective: To evaluate the efficacy and safety of super mini percutaneous nephrolithotomy (SMPCNL) in the treatment of upper urinary tract calculi treatment.Methods: The clinical data of 26 patients with upper urinary tract calculi treated by SMPCNL in our hospital from July 2015 to December were analyzed retrospectively.Results: SMPCNL was performed successfully on 26 patients.No heavy bleeding and bacterial infection occurred in any patient.The average operation time was (28.6±9.3) min,the average hemoglobin level before operation was (128.3±15.6) g/L,and decreased to (119.7±11.6) g/L after the operation.The urinary catheter was removed one day after the operation,and the mean postoperative hospital stay was (3.5±1.3) days.Conclusions: The clinical value of SMPCNL in the treatment of upper urinary tract calculi is significant,with advantages as small wound,less blood loss,no nephrostomy tube placement,rapid recovery and shorter hospital stay.It is recommended to practice in primary level hospitals.

Abstract:Objective:To systematically assess the efficacy and safety of holmium laser(HOLRBt)versus conventional transurethral resection(TURBT)for non muscle invasive bladder cancer(NMIBC).Methods:Ran-domized controlled trials(RCTs)regarding the efficacy and safety of HOLRBt vs.TURBT for NMIBC were re-trieved in PubMed,Cochrane library,Sciverse,CNKI,VIP and Wanfang database from databases establishment to Dec.2016.According to the including and exclusion criterion,two reviewers independently screened the trials, and the Meta-analysis was done with RevMan 5.3 soft ware.Results:A total of 14 RCTs were eligible for the study,including 1 746 cases.The pooled results showed that HOLRBt group had a less blood loss[MD = -66.00,95% CI=(80.75, -51.24),P< 0.000 01],and lower obturator reflex rate[RR= 0.06,95% CI=(0.02,0.16),P< 0.000 01]and perforation rate[RR= 0.15,95% CI=(0.07,0.33),P< 0.000 01]than TURBT group.However,there was no significant difference in operation time[MD= -0.14,95% CI=(-3.55,3.26),P=0.93]between two groups.Meanwhile,the one-year recurrence rate in HOLRBt group was sig-nificantly lower than that in TURBT group[RR=0.65,95% CI=(0.46,0.91),P=0.01].There was no sig-nificant difference in the 2-year recurrence rate between two groups[RR=0.52,95% CI=(0.20,1.37),P=0.19].Conclusions:Compared with TURBT,HOLRBt had less blood loss and lower obturator reflex rate and perforation rate.Therefore,HOLRBt should be considered as a preferable option for NMIBC.

Abstract:Objective:To investigate the anesthesia and analgesia effect of ultrasound-guided paravertebral block combined with dexmedetomidine anesthesia during percutaneous nephrolithotomy.Methods:106 patients un-dergoing elective percutaneous nephrolithotomy were randomly divided into two groups:treatment group and con-trol group.The treatment group was treated with ultrasound-guided paravertebral block and dexmedetomidine an-esthesia,while the control group was treated with ultrasound-guided paravertebral block,fentanyl and midazolam. The mean arterial pressure (MAP),heart rate (HR)and arterial oxygen saturation (SpO2)in the two groups were dynamically observed.The effect of sedation and comfort of the two groups were evaluated by Ramsay score and BCS score.Results:The MAP and HR in the treatment group were more stable than those in the control group,and there was no statistically significant difference between the two groups in SpO2.There was significant difference in Ramsay scores and BCS scores between two groups.There was no statistically significant difference in safety between the two groups.Conclusions:Ultrasound-guided paravertebral nerve block combined with dexme-detomidine anesthesia has advantage of good sedation,good analgesic effect and high safety,suitable for percuta-neous nephrolithotomy.

Abstract:Objective:To evaluate the safety,feasibility and efficacy of robot-assisted laparoscopic partial ne-phrectomy (RAPN)in treating renal tumors with R.E.N.A.L.score ≥10.Methods:All patients receiving RAPN by the same surgeon during May 2012 and Feb 2016 were reviewed.Among them,38 patients with high complex renal tumors (R.E.N.A.L.score ≥10)were enrolled in this study.The male/female ratio was 26/12 with a mean age of 51.0±11.9 (19-72)years.The mean body mass index was 25.2±3.4 (19.6-35.2)kg/m2 ,and the mean ASA score was 1.91±1.03 (1 to 2). All tumors were solitary including 16 on the left and 22 on the right.The mean diameter was 4.27±2.27 (2-16)cm.There were 31 cases and 7 cases with R.E.N.A.L.score 10 points and 11 points respectively.The mean preoperative estimated glomerular filtration rate was 97.9±24.3 (69.8-131.4) mL?min-1?1.73 m-2 .Results:All procedures were completed successfully except one conversion to open sur-gery for intraoperative bleeding.The mean operation time was 208.8±46.5 (105-308)min,ischemia time was 26.6±7.4 (14-49)min,and estimated blood loss was 150.3±115.5 (10-600)mL.The mean postoperative hos-pital stay was 14.4±3.6 (9-25)days.The overall rate of blood transfusion was 5.3% (2/38)and the complica-tion rate was 7.9% (3/38).No positive surgical margin was observed.Postoperative pathology results revealed 32 renal clear cell carcinomas,1 chromophobe renal cell carcinoma,1 TFE-3 fusion gene related renal cell carcinoma renal cell carcinoma and 4 angiomyolipomas.The meane eGFR decreased by 7.1% three months after operation with a significant difference compared to preoperativee eGFR (P<0.004).All patients had no local recurrence or distant metastasis during a mean follow-up period of 27.8±9.7 (9-51)months.Conclusions:Robot-assisted lapa-roscopic partial nephrectomy is safe and effective for high-complexity renal tumors with R.E.N.A.L.≥10.

Abstract:Objective:To investigate the clinical effect of single-tract percutaneous nephrolithotomy(PCNL) combined with flexible ureterorenoscopy in the second stage treatment of complicated renal calculi.Methods:A retrospective review was performed on 19 patients including 12 men and 7 women and the mean age was(48.7 ± 9.7)years.All patients underwent single-tract PCNL at the first stage.Then F20nephrostomy tubes were placed for 1-2 weeks and a second-stage operation was performed.Results:The maximum diameter of renal calculi was 1.6-3.5(2.5 ± 0.6)cm.The average operation time was 41-126(79 ± 24)min and the overall success rate was 84.2%(16/19).The mean hospital stay postoperation was(5.2 ± 0.9)days.There was one case of urosepsis af-ter operation.The patient was given vigorous anti-infectious therapy and eventually recovered.The incidence of surgical complications was 5.2%.Conclusions:Single-tract PCNL combined with flexible ureterorenoscopy for complicated renal calculi has the advantages of safety,effectiveness and less surgical trauma.In addition,the clea-rer field of vision during the operation could be obtained at the second stage compared with that of the first stage.

Abstract:Objective:To investigate the clinical safety and feasibility of robotic transumbilical laparoendoscopic single-site renal cyst decortication.Methods:From December 2013 to January 2014 ,3 cases of robotic transumbilical laparoendoscopic single-site renal cyst decortication were perfor med in our depart ment .The patient was placed in a 45°flankpositionfortransperitonealsurgery.A2-cmskinincisionaroundtheumbilicus was madeanddeepenedto the anterior rectus fascia ,then the peritoneum was incised and the Port was deployed .A8 .5-mmvideo-laparoscope , two 5-mmtrocars and a 5-mm assisted trocar were inserted through the Port syste m.Diagnostic laparoscopy was perfor med before robotic checking .The operative robot then was brought in over the patient'healthy side .Standard procedureoflaparoscopicrenalcystdecorticationwasperformed.Thespecimens wereremovedthroughtheumbilical incision.Results:Three cases of robotic transumbilical laparoendoscopic single-site renal cyst decortication were per-for med successfully with no conversion to open or 3-port laparoscopic approach .The operative ti me was 75 ,65 and 50 min,theestimatedbloodloss was20,15and10 mL,andthepostoperativehospitalstaywas2,3and3days,re-spectively.Nointro-operative complication was observed.There was no postoperative complications during a short follow-up period .Conclusions:Initial experience on robotic transumbilical laparoendoscopic single-site renal cyst decorticationhadshownitsclinicalsafetyandfeasibility.However,thoseresultsshouldbefurtherprovedbylarge sample,multiplecenters,randomcontrol studyandlong-termfollow-up.