Abstract:Methods A retrospective cohort study was conducted,and 195 elderly BPH patients with multiple comor-bidities who underwent surgical treatment in the Department of General Surgery,the 982nd Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army from June 2022 to November 2024 were included.Among them,65 patients underwent surgery under modified local anesthesia(LA group)and 130 patients under traditional epidural anesthesia(control group).After propensity score matching at a 1:1 ratio,there were 60 patients in each group.General clinical data,surgery-related safety and efficacy data were analyzed.Paired samples t-test was used for comparison of measurement data be-tween groups,paired rank sum test for ranked data,and McNemar test for count data.Results The baseline data of the two groups were comparable.In terms of safety indicators,the length of hospital stay in the LA group was significantly shorter than that in the control group(P<0.001),while there were no statistically significant differences in operation time,intraop-erative vital signs of patients,Visual Analogue Scale(VAS)pain score,and postoperative adverse events between the two groups(P>0.05).In terms of efficacy indicators,there were no statistically significant differences between the two groups[improvement in International Prostate Symptom Score(IPSS):P=0.817;improvement in maximum urinary flow rate(Qmax):P=0.950].Conclusion TUIP under modified local anesthesia is safe and effective for elderly BPH patients with multiple comorbidities.Due to the change in anesthesia method,it is more tolerant to patients'underlying diseases,enabling rapid postoperative recovery and discharge,which is conducive to patients receiving surgical treatment more safely and conve-niently.Objective To explore the safety and efficacy of transurethral incision of the prostate(TUIP)under modified local anesthesia in the treatment of elderly patients with benign prostatic hyperplasia(BPH)and multiple comorbidities.

Abstract:Objective To investigate the influencing factors of survival prognosis in patients after radical cystectomy and to further construct a nomogram predictive model,aiming to provide more guidance for early identification of high-risk groups with poor prognosis and subsequent formulation of individualized treatment plans.Methods A total of 136 patients with bladder cancer who underwent radical cystectomy at Zhongshan People's Hospital of Guangdong Province from January 2014 to January 2022 were retrospectively enrolled.Clinical,imaging,and follow-up survival data were recorded.Univariate and multivariate Cox proportional hazards models were used to identify independent influencing factors for overall survival(OS)after radical cystectomy.A nomogram predictive model for postoperative survival prognosis was constructed,and its clinical predictive efficacy was further evaluated.Results The median follow-up time for the 136 patients was 47.0(range,1.0-122.0)months,and the median OS was 32.0 months.Univariate analysis revealed that age,pathological histological grade,neutrophil-to-lymphocyte ratio(NLR),lymphocyte-to-monocyte ratio(LMR),platelet-to-lymphocyte ratio(PLR),and Magnetic Resonance Imaging Reporting and Data System(MRI-RADS)score for the bladder were all associated with survival prognosis after radical cystectomy(P<0.05).Multivariate analysis using the Cox proportional hazards model identi-fied age,pathological histological grade,NLR,LMR,PLR,and MRI-RADS score as independent influencing factors for survival prognosis(P<0.05).A nomogram was constructed based on these independent factors identified by multivariate analysis.The scores assigned were as follows:age(24 points),pathological histological grade(17 points),NLR(39 points),LMR(51 points),PLR(25 points),and MRI-RADS score(104 points).Receiver operating characteristic(ROC)curve analysis demonstrated that the model had an area under the curve(AUC)of 0.918(95%CI:0.844-0.982,P<0.001),a sensitivity of 91.47%,a specificity of 85.90%,and a Youden index of 0.786 for predicting survival prognosis after radical cys-tectomy.Conclusion The survival prognosis of patients after radical cystectomy were not only affected by age,histopatho-logical grade and surgical method,but also independently correlated with MRI bladder imaging report and data system score.Based on the above factors related to the nomogram model can accurately identify the high-risk population of poor postopera-tive survival prognosis.

Abstract:Objective To investigate the distribution of pathogenic bacteria and susceptible factors for urinary tract infection(UTI)in patients after retrograde intrarenal surgery(RIRS),and to provide evidence for the prevention of UTI in patients after RIRS.Methods The clinical data of 350 patients who underwent RIRS at Suzhou Ninth People's Hospital from August 2020 to August 2023 were collected retrospectively.According to the occurrence of postoperative UTI,the patients were divided into the infection group(61 cases)and the non-infection group(289 cases).The distribution of pathogenic bac-teria causing UTI in patients after RIRS was statistically analyzed,and univariate and multivariate analyses were used to iden-tify the susceptible factors for UTI in patients after RIRS.Results The main pathogenic bacteria causing UTI in patients af-ter RIRS were Escherichia coli,Pseudomonas aeruginosa,Enterococcus faecalis,and Enterococcus faecium.The suscepti-ble factors included complicated diabetes mellitus,indwelling urinary catheter duration≥7 days,renal pelvic pressure≥30 mmHg(1 mmHg=0.133 kPa),and preoperative urine leukocyte count≥2 cells/HP(P<0.05).Prophylactic use of antibacte-rial agents was identified as a protective factor(P<0.05).Conclusion The main pathogenic bacteria causing UTI in pa-tients after RIRS are Escherichia coli,Pseudomonas aeruginosa,Enterococcus faecalis,and Enterococcus faecium.The sus-ceptible factors for UTI are related to the presence of diabetes mellitus,indwelling urinary catheter duration,renal pelvic pressure,prophylactic use of antibacterial agents,and preoperative urine leukocyte count.

Abstract:Objective To compare the therapeutic efficacy of robot-assisted,laparoscopic,and open surgical repair for vesicovaginal fistula(VVF),and to explore the related factors influencing the treatment outcome.Methods A retrospec-tive analysis was performed on the clinical data of 58 VVF patients who underwent surgical repair by a single surgeon in a sin-gle ward of the First Affiliated Hospital of Zhengzhou University from December 2015 to July 2024.Among them,10 cases were treated with robot-assisted surgery(robot-assisted group),20 cases with laparoscopic surgery(laparoscopic group),and 28 cases with open surgery(open surgery group).The surgical indicators and follow-up outcomes were compared among the three groups,and the causes of VVF repair failure were investigated.Results The median age of the patients was 50(44,53)years,and the median disease duration was 8(3,12)months.Of all patients,50 cases(86.21%,50/58)developed VVF secondary to gynecological surgery;20 cases(34.48%,20/58)had fistulas located in the trigone of the bladder;18 cases(31.03%,18/58)had a history of previous repair surgery;8 cases(13.79%,8/58)had multiple fistulas,with the median max-imum diameter of fistulas being 0.6(0.5-1.5)cm.A total of 50 cases(86.21%,50/58)achieved successful VVF repair,while 8 cases(13.79%,8/58)experienced repair failure.The open surgery group had a longer disease duration[9(8,30)months]than the robot-assisted group[5(3,12)months]and the laparoscopic group[3(3,6)months],and a higher rate of multiple previous repairs(46.43%,13/28 vs.30%,3/10 and 10%,2/20),with statistically significant differences(P<0.001,P=0.028).The open surgery group also had a longer operative time(122 min vs.87 min and 84 min)and greater intraoperative blood loss(100 ml vs.25 ml and 20 ml)compared with the robot-assisted group and laparoscopic group,with statistically sig-nificant differences(P=0.003,P<0.001).Univariate Logistic regression analysis showed that surgical approach,fistula size,number of fistulas,fistula coverage material,and disease duration had no statistically significant effects on the success of VVF repair(all P>0.05).In contrast,the etiology of VVF(P<0.001),fistula located in the trigone of the bladder(P=0.007),factors affecting wound healing(P=0.031),and postoperative complications(P<0.001)were significantly correlat-ed with the success of fistula repair.Conclusions Compared with open surgery,robot-assisted or laparoscopic surgery for VVF repair has shorter operative time,less intraoperative blood loss,and similar surgical success rate,which is a safe and ef-fective method for VVF repair.The etiology of VVF,fistula location,and factors affecting wound healing are the key factors influencing the success of VVF repair.

Abstract:Objective To investigate the predictive value of preoperative prognostic nutritional index(PNI)com-bined with serum Krüppel-like factor 5(KLF5)and paraoxonase 1(PON1)for postoperative recurrence in bladder cancer pa-tients undergoing transurethral resection.Methods A total of 135 bladder cancer patients diagnosed and treated with trans-urethral resection in Mianyang Central Hospital from January 2020 to January 2022 were prospectively enrolled as subjects.They were divided into the recurrence group(n=42)and non-recurrence group(n=93)based on postoperative recurrence sta-tus.The PNI was calculated from preoperative blood routine test results.Serum KLF5 and PON1 levels were measured using enzyme-linked immunosorbent assay(ELISA).Pearson correlation analysis was performed to evaluate the correlations be-tween preoperative PNI and serum KLF5 and PON1 levels in bladder cancer patients.Logistic regression analysis was used to identify the key factors influencing postoperative recurrence in bladder cancer patients.Receiver operating characteristic(ROC)curve was applied to assess the predictive value of preoperative PNI combined with serum KLF5 and PON1 for post-operative recurrence in bladder cancer patients.Results During the 2-year postoperative follow-up,42 out of 135 bladder cancer patients experienced recurrence,with a recurrence rate of 31.11%.The proportions of multiple tumors and T1 stage tu-mors,as well as serum KLF5 levels in the recurrence group were significantly higher than those in the non-recurrence group(P<0.05),while preoperative PNI and serum PON1 levels were significantly lower in the recurrence group(P<0.05).Pre-operative PNI was negatively correlated with serum KLF5 levels(r=-0.709,P<0.001)and positively correlated with serum PON1 levels(r=0.675,P<0.001).Elevated serum KLF5 levels were identified as risk factors for postoperative recurrence in bladder cancer patients,whereas increased preoperative PNI and serum PON1 levels were protective factors(P<0.05).The areas under the curve(AUCs)of preoperative PNI,serum KLF5,serum PON1 alone and their combination for predicting postoperative recurrence in bladder cancer patients were 0.820,0.868,0.826 and 0.955,respectively;the sensitivities were 66.67%,80.95%,73.81%and 90.48%,respectively;and the specificities were 87.10%,91.40%,78.49%and 88.17%,respec-tively.The predictive efficacy of the combined detection was superior to that of single detection(Z combination-PNI=3.814,Z combina-tion-KLF5=2.819,Z combination-PON1=3.792,P<0.05).Conclusion Elevated serum KLF5 levels,decreased preoperative PNI and serum PON1 levels in bladder cancer patients are closely associated with postoperative recurrence after transurethral resection.The combined detection of the three indicators has higher value in predicting postoperative recurrence in such patients.

Abstract:Congenital median perineal fissure is a rare congenital malformation of the genital system in children,which is present at birth and prone to missed diagnosis due to insufficient clinical awareness.To enhance the understanding of this disease among pediatric urologists and emphasize the importance of early diagnosis and timely treatment,this paper retro-spectively analyzed the clinical data of a female child with complete congenital median perineal fissure and conducted a litera-ture review.The child was treated with linear excision and suture.Pathological examination revealed squamous epithelial hy-perplasia and mild parakeratosis of the superficial layer.Primary wound healing was achieved one week after surgery,and slight local protuberance of the perineal groove was observed one month postoperatively.Congenital median perineal fissure has a low clinical incidence,and accurate diagnosis requires collaboration between neonatologists and pediatric surgeons.The linear excision and suture method is simple to operate,allows for rapid postoperative recovery,and has demonstrated reliable efficacy in existing surgical cases,thus serving as one of the preferred surgical options for this disease.

Abstract:Duplicated renal-ureteral malformation is one of the common congenital malformations of the urinary sys-tem.Most cases present as unilateral lesions,while the coexistence of bilateral duplicated renal-ureteral malformation and uni-lateral ectopic kidney is rare.Most patients have no significant clinical manifestations;however,when hydronephrosis occurs due to ureteral stenosis or obstruction,it is easily confused with simple renal cysts.This article reports a case of bilateral dupli-cated renal-ureteral malformation complicated with giant hydronephrosis in one ectopic kidney,aiming to provide a reference for clinical treatment.

Abstract:Objective To establish and validate a nomogram model for predicting postoperative recurrence based on the independent factors associated with the recurrence risk of ureteral calculi after surgery.Methods A total of 229 patients with ureteral calculi who underwent ureteroscopic lithotripsy in Suzhou Integrated Traditional Chinese and Western Medicine Hospital from January 2022 to January 2025 were retrospectively enrolled.The patients were randomly divided into the train-ing set(n=160)and validation set(n=69)at a ratio of 7:3.According to the recurrence status within 1 year after surgery,the patients in the training set were further categorized into the recurrence group(n=59)and non-recurrence group(n=101).Uni-variate and multivariate Logistic regression analyses were performed to identify the independent influencing factors for postop-erative recurrence of ureteral calculi.The predictive efficacy,calibration degree,and clinical utility of the nomogram model were evaluated using the area under the receiver operating characteristic(ROC)curve(AUC),calibration curves,and deci-sion curve analysis(DCA).Results Among the 229 patients with ureteral calculi,82 cases experienced postoperative recur-rence,with a recurrence rate of 35.81%.Multivariate Logistic regression analysis revealed that ureteral obstruction,postoper-ative residual calculi,maximum stone diameter,number of calculi,and impacted calculi were independent risk factors for postoperative recurrence of ureteral calculi(P<0.05).The results of model performance evaluation indicated that the model had good consistency(χ2=4.678,2.810;P=0.581,0.786),diagnostic efficacy(AUC=0.922,0.919),and clinical net benefit in both the training set and validation set.Conclusion The nomogram predictive model for postoperative recurrence of ure-teral calculi,which is established based on clinical features including ureteral obstruction,postoperative residual calculi,maximum stone diameter,number of calculi,and impacted calculi,exhibits favorable predictive efficacy and clinical applica-tion value.

Abstract:Objective To investigate the effect of laparoscopic orchiopexy on the short-term and long-term curative effects as well as testicular development in patients with inguinal cryptorchidism.Methods A total of 100 patients with in-guinal cryptorchidism admitted to Qinhuangdao Maternal and Child Health Hospital were prospectively selected as the re-search subjects.According to the random number table method,they were divided into a traditional group and a laparoscopic group,with 50 cases in each group.Patients in the traditional group were treated with conventional orchiopexy,while those in the laparoscopic group were treated with laparoscopic orchiopexy.The surgery-related indicators,short-term and long-term curative effects,and testicular development were compared between the two groups.Results The intraoperative blood loss in the laparoscopic group was less than that in the traditional group(P<0.05),and the time to get out of bed after surgery and the length of hospital stay were shorter than those in the traditional group(P<0.05).At 6 months after surgery,the effec-tive rate of the laparoscopic group was higher than that of the traditional group(P<0.05);at 12 months after surgery,there was no statistically significant difference in the long-term curative effect between the two groups(P>0.05).At 6 months af-ter surgery,the serum levels of anti-Müllerian hormone(AMH)and inhibin B(INHB)in both groups were higher than those before surgery(P<0.05),and there was no statistically significant difference between the two groups(P>0.05).Conclu-sion Laparoscopic orchiopexy can promote postoperative recovery in patients with inguinal cryptorchidism,exert favorable short-term and long-term curative effects,and facilitate testicular development.

Abstract:Objective To compare the therapeutic efficacy of flexible ureteroscopy(f-URS)and mini-percutaneous nephrolithotomy(mPCNL)in the treatment of multiple renal calculi sized 1-2 cm.Methods The clinical data of patients with 1-2 cm multiple renal calculi who underwent f-URS or mPCNL at Zhuzhou Hospital Affiliated to Xiangya School of Medicine,Central South University from January 2022 to June 2024 were retrospectively analyzed.Propensity score match-ing(PSM)was applied for cohort matching,and a total of 120 patients were enrolled.All patients were divided into two sub-groups according to the number of calculi(≤3 vs.>3 calculi).The safety and effectiveness of the two surgical approaches were compared.Results The f-URS group showed significant advantages over the mPCNL group in terms of postoperative hospital stay[(3.05±1.52)d vs.(7.63±1.48)d,t=15.060,P<0.001],operative time[(84.91±38.92)min vs.(100.58±29.29)min,t=2.370,P=0.027],and complication rate[8.8%vs.30.0%,χ2=7.530,P=0.006].There was no statistically signifi-cant difference in stone-free rate between the two groups(P>0.05).In the subgroup with≤3 calculi,the f-URS group had shorter operative time[(77.59±40.73)min vs.(100.04±28.56)min,t=2.500,P=0.015]and lower complication rate[6.5%vs.23.1%,χ2=4.180,P=0.041]compared with the mPCNL group.However,no statistically significant differences were ob-served between the two surgical approaches in the subgroup with>3 calculi(P>0.05).Conclusion For multiple renal stones measuring 1-2 cm,f-URS can achieve stone-free rates comparable to those of mPCNL when the number of stones is≤3,while offering shorter postoperative recovery,reduced operative time,and a lower risk of complications.When the number of stones exceeds 3,the clinical efficacy of the two surgical approaches appears to be comparable.

Abstract:Objective To systematically evaluate the effect of radical prostatectomy(RP)combined with endocrine therapy on the prognosis of patients with oligometastatic prostate cancer(OmPCa).Methods In this study,OmPCa was clearly defined as 1-5 bone and/or lymph node metastatic lesions(excluding visceral metastases).Endocrine therapy was limited to traditional medical castration therapy(excluding novel endocrine agents such as abiraterone).Chinese and English databases were searched(up to March 1,2025)to include clinical studies comparing RP combined with endocrine therapy(combined treatment group)and endocrine therapy alone(single treatment group)for OmPCa.Meta-analysis was performed using RevMan 5.4 software,and hazard ratios(HR)with 95%confidence intervals(CI)were calculated.Results A total of 13 studies involving 1,120 patients were included.The results of Meta-analysis showed that the combined treatment group was significantly superior to the single treatment group in terms of radiologic progression-free survival(rPFS,HR=0.41,95%CI:0.30-0.55,P<0.00001),castration-resistant progression-free survival(CRFS,HR=0.57,95%CI:0.47-0.70,P<0.00001),cancer-specific survival(CSS,HR=0.41,95%CI:0.31-0.55,P<0.00001),overall survival(OS,HR=0.53,95%CI:0.37-0.75,P=0.0004),and complication rate(RD=-0.23,95%CI:-0.32--0.14,P<0.00001).No significant het-erogeneity was observed for all outcomes(I²<50%).Conclusion RP combined with endocrine therapy can improve the prognosis of patients with OmPCa,but clinical decisions still need to comprehensively evaluate the individual characteristics of patients and surgical risks.

Abstract:Objective To establish a nomogram model for individualized prediction of recurrence risk in patients with non-muscle-invasive bladder cancer(NMIBC)after transurethral resection of bladder tumor(TURBT).Methods A to-tal of 208 NMIBC patients admitted to Qinhuangdao First Hospital from January 2019 to June 2022 were selected.Logistic re-gression analysis was used to screen the independent risk factors for recurrence in NMIBC patients after TURBT,and a nomo-gram was constructed to evaluate its discrimination and calibration.Results Among the 208 NMIBC patients,51 cases(24.52%)had recurrence after TURBT.Logistic regression analysis showed that overweight or obesity(OR=3.010,P=0.010),multiple tumors(OR=4.410,P=0.000),maximum tumor diameter>3 cm(OR=5.331,P=0.000),pathological stage T1(OR=8.359,P=0.000),and no immediate intravesical instillation(OR=4.462,P=0.016)were independent risk fac-tors for recurrence in NMIBC patients after TURBT.The area under the receiver operating characteristic(ROC)curve was 0.872(95%CI:0.817-0.927).The calibration curve was close to the"Y=X diagonal line",and the Hosmer-Lemeshow goodness-of-fit test showed χ2=8.225,P=0.313.Conclusion A column chart based on overweight or obesity,multiple tu-mors,maximum tumor diameter>3 cm,pathological stage T1,and lack of immediate bladder perfusion can predict the re-currence risk of NMIBC patients after TURBT in an individualized manner.

Abstract:Objective To establish an early warning model for urinary incontinence(UI)complicating robot-assisted laparoscopic radical prostatectomy(RARP)in middle-aged and elderly patients based on clinical data.Methods A retro-spective analysis was performed on clinical data of 209 middle-aged and elderly patients who underwent RARP at the Affiliat-ed Drum Tower Hospital of Nanjing University Medical School from July 2022 to January 2024.According to the occurrence of UI at 3 months after surgery,the patients were divided into the UI group and non-UI group.The clinical data of the two groups were collected and compared.LASSO-Logistic regression analysis was applied to identify the influencing factors of postoperative UI in middle-aged and elderly patients undergoing RARP.The R software was used to construct a nomogram model.Receiver operating characteristic(ROC)curve and calibration curve were plotted to evaluate the value of the nomo-gram model in predicting the occurrence of postoperative UI.Results Compared with the non-UI group,the UI group had significantly higher proportions of patients with older age,higher body mass index(BMI),preoperative Gleason score of 7 points,postoperative pathological stage T3,preoperative anxiety or depression,decompensated bladder function,and pros-tate volume>40 mL,while the proportion of patients with intraoperative bladder neck preservation was significantly lower(all P<0.05).Age≥70 years,obesity,preoperative prostate volume>40 mL,preoperative Gleason score of 7 points,postoperative pathological stage T3,preoperative anxiety or depression,preoperative decompensated bladder function,and intraoperative bladder neck preservation were independent influencing factors for postoperative UI(all P<0.05).The early warning model for postoperative UI constructed based on the above factors showed a C-index of 0.818 and an area under the curve(AUC)of 0.909(95%CI:0.871-0.947).The calibration curve demonstrated high predictive accuracy of the model.Conclusion Age≥70 years,obesity,preoperative prostate volume>40 mL,preoperative Gleason score of 7 points,post-operative pathological stage T3,preoperative anxiety or depression,preoperative decompensated bladder function,and intra-operative bladder neck preservation are independent influencing factors for postoperative UI.The early warning model con-structed based on these factors has high accuracy and predictive efficacy,which can accurately identify potential high-risk populations at an early stage and facilitate the formulation of preventive measures to reduce the incidence of postoperative UI.

Abstract:Methods A retrospective analysis was performed on the clinical data of 95 patients with clinically stagedⅠ(pT1)renal cell carcinoma admitted to the Department of Urology,the 908th Hospital of the Joint Logistics Support Force of the Chinese People's Liberation Army,from October 2020 to January 2022.According to the surgical method,patients were divided into two groups:47 patients who received traditional LPN(with renal artery clamping)were assigned to the control group,and 48 patients who underwent LPN combined with zero-ischemia microwave ablation for renal cell carcinoma were assigned to the study group.The SPSS 25.0 statistical system was used to analyze and compare perioperative conditions,renal function indicators before and after surgery,inflammatory-stress factors,quality of life,functional status,and renal re-gion pain intensity between the two groups.The incidence of postoperative complications and recurrence rate were also com-pared between the two groups.Results Independent samples t-test showed that the operation time of the study group[(64.28±11.79)minutes]was longer than that of the control group[(57.61±10.83)minutes],while the postoperative drain-age time[(5.19±1.06)days]and hospital stay[(11.28±2.47)days]were shorter than those of the control group[(6.54±1.37)days and(14.35±3.12)days,respectively],with statistically significant differences(all P<0.05).On the 3rd day after surgery,the levels of C-reactive protein(CRP),tumor necrosis factor-α(TNF-α),malondialdehyde(MDA),and epineph-rine(E)in the study group were(12.67±2.18)mg/L,(24.59±7.43)ng/L,(2.56±0.49)μmol/L,and(40.79±7.05)μg/L,respectively,which were lower than those in the control group[(15.30±2.79)mg/L,(30.42±8.16)ng/L,(3.12±0.57)μmol/L,and(48.21±7.84)μg/L,respectively],with statistically significant differences(all P<0.05).At 3 months after surgery,the levels of serum creatinine(Cr)and blood urea nitrogen(BUN)in the study group were(95.13±17.65)μmol/L and(4.12±1.10)mmol/L,respectively,lower than those in the control group[(112.39±20.18)μmol/L and(7.36±1.59)mmol/L,respectively];the estimated glomerular filtration rate(eGFR)and creatinine clearance rate(Ccr)in the study group were(76.18±5.63)mL/min and(68.54±9.31)mL/min,respectively,higher than those in the control group[(71.49±5.21)mL/min and(57.26±8.85)mL/min,respectively],with statistically significant differences(all P<0.05).At 3 months after sur-gery,the scores of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30(EORTC QLQ-C30)and Karnofsky Performance Status(KPS)in the study group were(78.53±7.11)and(86.19±4.38),respectively,higher than those in the control group[(73.46±7.68)and(82.45±5.17),respectively];the Visual Analogue Scale(VAS)score for pain in the study group[(0.95±0.31)]was lower than that in the control group[(1.46±0.43)],with statistically significant differences(all P<0.05).Chi-square test showed that the total incidence of complications in the study group was 4.17%,which was lower than 19.15%in the control group,with a statistically significant difference(P<0.05).There was no statistically significant difference in the 1-year postoperative recurrence rate between the two groups(P>0.05).Conclusion LPN combined with zero-ischemia microwave ablation for Stage Ⅰ renal cell carcinoma can achieve zero isch-emia,reduce the body's inflammatory-stress response,decrease postoperative complications,have less impact on renal func-tion,and help alleviate renal region pain,improve the body's functional status and quality of life.Objective To explore the clinical efficacy of laparoscopic partial nephrectomy(LPN)combined with zero-ischemia microwave ablation for Stage Ⅰ re-nal cell carcinoma,and its effects on renal function,complications,and quality of life.

Abstract:Unilateral polycystic kidney is relatively rare,with very few reported cases worldwide.This study reports a case of a 59-year-old female patient with unilateral polycystic kidney,whose right kidney was polycystic while the left kidney was normal.She presented with right lumbar soreness and discomfort and underwent laparoscopic renal cyst decortication.This case aims to help improve clinical understanding of polycystic kidney disease,facilitate early diagnosis and treatment,and enhance patient prognosis.

Abstract:Objective To explore the combined predictive value of preoperative serum Toll-like receptor 4(TLR4)/nuclear factor-kappa B(NF-κB)and urinary leukocyte esterase(ULE)for urinary tract infection(UTI)after flexible uretero-scopic holmium laser lithotripsy(F-URS).Methods A prospective study was conducted on 300 patients with upper urinary tract calculi admitted to Zigong Fourth People's Hospital from January 2023 to May 2024.All patients underwent F-URS.Ac-cording to the occurrence of postoperative UTI,patients were divided into the infection group(46 cases)and the non-infec-tion group(254 cases).Baseline data,preoperative serum levels of TLR4 and NF-κB,and positive rate of ULE were com-pared between the two groups.Pearson correlation coefficient was used to analyze the correlations between preoperative se-rum TLR4,NF-κB,ULE and conventional inflammatory indicators[white blood cell count(WBC),C-reactive protein(CRP),procalcitonin(PCT)].Logistic regression analysis was performed to explore the relationship between preoperative serum TLR4,NF-κB,ULE and postoperative UTI.Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to evaluate the predictive value of preoperative serum TLR4,NF-κB,ULE and conventional inflammatory indicators for postoperative UTI.Results The infection group had higher age,higher proportion of previous stone surgery history,and higher preoperative levels of WBC,CRP and PCT than the non-infection group(all P<0.05).Preoperative se-rum levels of TLR4 and NF-κB in the infection group were higher than those in the non-infection group,and positive rate of ULE were lower than those in the non-infection group(all P<0.05).Patients with positive ULE had higher preoperative se-rum levels of TLR4 and NF-κB than those with negative ULE(all P<0.05).Logistic regression analysis showed that age,previous stone surgery history,preoperative serum TLR4,NF-κB and ULE were independent influencing factors for postop-erative UTI after F-URS(all P<0.05).After adjusting for age and previous stone surgery history,preoperative serum TLR4,NF-κB and ULE remained independent influencing factors for postoperative UTI after F-URS(all P<0.05).ROC curve anal-ysis showed that the AUCs of preoperative serum TLR4,NF-κB and ULE for predicting postoperative UTI after F-URS were 0.778,0.763 and 0.751,respectively,which were slightly higher than those of conventional inflammatory indicators WBC,CRP and PCT(0.726,0.735 and 0.725).Subsequently,a combined prediction model of preoperative serum TLR4,NF-κB and ULE was constructed.The AUC of the combined prediction of preoperative serum TLR4,NF-κB and ULE for postopera-tive UTI after F-URS was 0.921,which was significantly higher than the predictive value of each indicator alone(Z=3.621,3.805,4.033,all P<0.001).Conclusion Preoperative serum TLR4/NF-κB combined with ULE can reliably predict the risk of UTI after F-URS,which can help clinicians take scientific prevention and treatment measures.

Abstract:Neuromodulation technology represents a significant advancement in the field of urology,among which tibial nerve stimulation(TNS)has attracted considerable attention due to its advantages of safety and ease of operation.This study systematically reviews the mechanism of action,clinical evidence,and application prospects of TNS in the treatment of lower urinary tract dysfunction.It elaborates on the anatomical basis,technical classification,and parameter optimization strategies of TNS,and compares its efficacy with sacral neuromodulation,pharmacotherapy,and behavioral therapy.With technological innovations such as real-time closed-loop regulation systems,in-depth research on the mechanism of action,im-provement of individualized parameter protocols,and the promotion of health economic evaluations,TNS is expected to be-come an important option for the treatment of lower urinary tract dysfunction,driving the field toward intelligent,precise,and accessible development.

Abstract:Objective To explore the clinical application experience of radical prostatectomy combined with periure-thral total reconstruction using the domestic Toumai surgical robot system versus laparoscopic endoscopic system,and to pre-liminarily evaluate the safety and efficacy of the domestic robot.Methods A retrospective analysis was conducted on the clinical data of 43 patients with prostate cancer admitted to the Department of Urology,the First Affiliated Hospital of Yang-tze University,from March 20,2020,to March 20,2024.According to the surgical method,the patients were divided into the robot-assisted laparoscopic radical prostatectomy(RALP)group(22 cases)and the laparoscopic radical prostatectomy(LRP)group(21 cases).The prostate cancer stage,body mass index(BMI),Gleason score,surgical margin status,opera-tion time,blood loss,postoperative hospital stay,perioperative complications,postoperative pathology,preoperative serum prostate-specific antigen(PSA),and immediate urinary continence after urinary catheter removal were compared between the two groups.Results here were no statistically significant differences in general data such as age and body weight between the two groups(P>0.05).All surgeries were successfully performed under general anesthesia without changing the surgical method during the operation;all operations were completed by a single surgeon,and no intraoperative complications or de-vice-related adverse events occurred.There were no statistically significant differences between the two groups in preoperative total prostate-specific antigen(tPSA),intraoperative blood loss,postoperative hospital stay,surgical operation time,imme-diate urinary continence rate,and tPSA at 6 weeks postoperatively(P>0.05).Conclusion The application of the domestic Toumai robot in radical prostatectomy for prostate cancer is safe and feasible.

Abstract:Objective To address the issues of insufficient precision and high difficulty in laparoscopic suturing,this study aimed to establish and promote the 360° suturing theory,which is based on 360° needle holding to ensure precise suturing.Methods The 360° suturing theory was proposed,consisting of four core frameworks:the principle of simplified needle adjustment,the principle of vertical needle insertion,the horizontal 360° suturing method,and the simplified vertical suturing method.Relevant derivative issues of this theory were also elaborated.A 360° suturing training module was devel-oped,and a 360° suturing training program—comprising three parts:theoretical explanation,simulation box practice and testing,and telephone follow-up—was implemented to help surgeons improve their suturing skills.This program was used to verify the effectiveness and ease of promotion of the 360° suturing theory.Results From April 2023 to April 2024,223 sur-geons from 6 medical centers in China participated in the 360° suturing training program.The surgeons were divided into groups based on their years of laparoscopic surgery experience:Group A(56 surgeons),Group B(84 surgeons),Group C(63 surgeons),and Group D(20 surgeons),with a median laparoscopic surgery experience of 11.9 years.After training,81 surgeons(36.3%)completed 12 stitches of 360° suturing within 6 minutes,87 surgeons(39.0%)completed it within 12 min-utes,and 55 surgeons(24.7%)completed it within 24 minutes.Eighty surgeons were followed up by telephone.Regarding whether the training helped improve laparoscopic suturing skills,reduced the rate of conversion to open surgery and robotic surgery,ensured precise suturing,and whether the training model was easy to replicate,all 80 surgeons(100%)expressed satisfaction;78 surgeons(97.5%)considered the theory easy to understand;and 62 surgeons(77.5%)believed the theory could be easily applied in clinical suturing.Conclusions The 360° suturing theory is simple and feasible.It can help sur-geons perform precise laparoscopic suturing and reduce the proportion of conversions to open surgery and robotic surgery.

Abstract:Objective To explore the effects of one-lung ventilation(OLV),intermittent apnea ventilation(IAV),and conventional mechanical ventilation(CMV)on respiratory stability,oxygenation efficiency,and perioperative safety during flexible ureteroscopic lithotripsy(FURL),and to provide evidence for optimizing anesthetic management.Methods A randomized controlled study was conducted on patients with unilateral simple renal calculi(diameter≤2.5 cm)and upper ureteral calculi who underwent FURL at Leshan Shizhong District People's Hospital from April 2023 to December 2024.The patients were randomly divided into three groups at a ratio of 1:1:1:OLV group,IAV group,and CMV group.Intraoperative oxygenation indicators[arterial partial pressure of oxygen(PaO₂),arterial partial pressure of carbon dioxide(PaCO₂),pulse oxygen saturation(SpO₂)],hemodynamic parameters[mean arterial pressure(MAP),heart rate(HR)],metabolic indica-tors[lactate(Lac),pH value],lithotripsy time,number of mucosal injuries,degree of injury,postoperative fever,surgeon satisfaction score,and anesthetic recovery indicators[awakening time,post-anesthesia care unit(PACU)stay time,Steward score]were recorded and statistically analyzed.Results The OLV group was significantly superior to the other two groups in oxygenation capacity,operation time,surgeon satisfaction score,and postoperative recovery(awakening time,PACU stay time,Steward score);it also had the lowest number of mucosal injuries,degree of mucosal injury,and postoperative fe-ver rate.In the IAV group,the switching between apnea and ventilation led to prolonged operation time(P<0.001),and Pa-CO₂ increased significantly at 5 minutes before the end of lithotripsy(P<0.001),but no significant change in pH was ob-served.In the CMV group,due to interference from respiratory movement,the number of mucosal injuries and the degree of injury were the most severe(P<0.001),and the postoperative fever rate was the highest(50%).A positive correlation was found between the degree of mucosal injury and postoperative fever(OR=2.479,P=0.004).Conclusion OLV can signifi-cantly improve the stability of FURL,shorten the operation time,and reduce the risk of tissue injury and infection,making it the preferred anesthetic strategy for complex upper urinary tract calculi.For IAV,the balance between CO₂ accumulation and operational continuity should be considered,and it is suitable for experienced teams.The positive correlation between the de-gree of mucosal injury and fever in the CMV group suggests that preoperative infection control and intraoperative irrigation pressure monitoring should be strengthened.