ObjectiveBased on two-dimensional transperineal pelvic floor ultrasound images obtained during the Valsalva maneuver，this study aims to develop a deep learning artificial intelligence model to assist in the clinical grading diagnosis of female stress urinary incontinence （SUI）.MethodsAll patients underwent transperineal pelvic floor ultrasound examination within one month of their initial visit. According to the International Consultation on Incontinence Questionnaire-Short Form （ICI-QSF），the SUI patients were divided into three groups: mild （S1），moderate （S2），and severe （S3）. Baseline information and ultrasound images of the patients were collected，and midsagittal plane images of the pelvic floor during the Valsalva maneuver were selected. After preprocessing，the regions of interest（ROI） were semi-automatically segmented using computer algorithms. A transfer learning approach was applied using a ResNet50 model pretrained on ImageNet. The data were randomly divided into a training set and a test set in an 8∶2 ratio，with five-fold cross-validation performed on the training set. After model training，performance was evaluated using a confusion matrix and the area under the receiver operating characteristic curve （AUC）. Finally，gradient-weighted class activation mapping （Grad-CAM） was used to generate heatmaps to visually demonstrate the areas of interest identified by the model.ResultsA total of 282 patients were included in the study，comprising 167 patients with SUI and 115 non-SUI patients（S0）. The model achieved an accuracy of 84.1% in the training set and 83.9% in the test set. The AUC values in the training set were as follows: non-SUI 0.89 （95%CI: 0.78-0.97），mild SUI 0.96 （95%CI: 0.90-1.00），moderate SUI 0.92 （95%CI: 0.81-1.00），and severe SUI 0.93 （95%CI: 0.84-0.98）. In the test set，the AUC values were non-SUI 0.88 （95%CI: 0.77-0.98），mild SUI 0.91 （995%CI: .80-0.99），moderate SUI 0.92 （95%CI: 0.80-1.00），and severe SUI 0.88 （95%CI: 0.75-0.98）.ConclusionThe grading diagnostic artificial intelligence model based on two-dimensional transperineal pelvic floor ultrasound images during the Valsalva maneuver shows potential to become an objective basis for the grading diagnosis of SUI patients.
Objective:To investigate the safety and efficacy of 3D laparoscopy combined with ureteroscopy in the treatment of ureteropelvic junction obstruction complicated with calyx calculi.Methods:The clinical data of 14 patients with renal pelvic ureteral junction obstruction and renal calyx stones who were admitted and operated in Guangdong Second Provincial General Hosptial from December 2019 to January 2022 were analyzed retrospectively. The size of kidney stones, number of stones, operation time, intraoperative blood loss, and one-stage stone removal rate and surgical effect were collected and analyzed. Results:All patients underwent transabdominal 3D laparoscopic nephroplasty. The ureteroscope was placed in the renal pelvis and calyces through the laparoscopic channel to find and remove calyx stone. The mean stone size was (0.89±0.32) cm, the number of stones was 2-6, the operation time was (138±18) min, the intraoperative blood loss was (12±5) ml, the primary stone clearance rate was 100%, The ureteral stent was removed 6-8 weeks after operation, and CT scan revealed hydronephrosis significant reduced or disappeared 3 month after operation, and there was no recurrence of renal calculus or aggravation of hydronephrosis.Conclusion:3D laparoscopy combined with rigid ureteroscopy is safe, effective, minimal invasive and has a high stone removal rate in the treatment of renal pelvic ureteral junction obstruction with calyx calculus, which is a good alternative therapy for partial UPJO with calyx calculi patients.
肾结石的发病率很高，是泌尿外科的常见疾病之一[1]。最常见的结石成分是以钙盐为基础[2]。肾结石的形成受遗传和环境因素的影响[3-4]。饮食习惯属于后者，饮食因素可导致尿成分异常等[5]，而较高的尿钙排泄是肾结石形成的重要危险因素[6]。因此，对钙盐结石者的营养建议包括增加液体、蔬菜和水果的摄入，平衡钙摄入，减少钠和动物蛋白的摄入等[7]。考虑到钙的吸收导致结石患者尿钙水平增加，理论上补充维生素D可能会增加钙的吸收和结石形成。虽然现有的关于膳食钙摄入的文献都支持钙饮食增加结石形成风险，但关于维生素D摄入和钙补充的数据不太一致[8-9]。因此，本研究旨在综述钙和维生素D与肾结石形成关系的研究现状及进展，为相关研究提供参考。
Objective:To analyze the expression and significance of orphan nuclear receptor HNF4α in renal clear cell carcinoma.Methods:The expression pattern of HNF4α in renal clear cell carcinoma and its related overall survival was analyzed by UALCAN. The expression of HNF4α mRNA in tumor, normal and metastatic tissues of renal clear cell carcinoma was analyzed by TNMplot. The prognostic significance of HNF4α in renal clear cell carcinoma was evaluated in Kaplan-Meier plotter online database. STRING analysis was used to analyze the HNF4α related protein-protein interaction networks.Results:HNF4α was significantly down regulated in renal clear cell carcinoma as compared to its normal control (P=0.002). The expression level of HNF4α was lower in metastatic renal clear cell carcinoma than that in primary tumor tissues (P<0.001). The expression level of HNF4α in stage 4 was significantly lower than that in stage 1 (P=0.007), and in grade 4 was significantly lower than that in grade 3 (P<0.001). The expression level of HNF4α was positively correlated with tumor prognosis (P=0.017). The overall survival rate of HNF4α-low expressed group was significantly lower than that of high expression group (P<0.001). There were 27 genes positively correlated with the expression of HNF4α with Pearson correlation coefficient greater than 0.5, including ERBB3, CUBN, HNF1A and CES2. There were interactions between HNF4α and HNF1A, EP300, LEF1, SMAD3, SMAD4, NCOA1, HIF1A, FOXO1 and PPARGC1A. The interaction network node is 11, and the PPI enrichment P value is 3.44e-08. Conclusions:HNF4α is significantly down regulated in renal clear cell carcinoma and negatively correlated with tumor prognosis. HNF4α and its related interaction factors may play important roles in the renal clear cell carcinoma. However, the role and mechanism of HNF4α in renal clear cell carcinoma need to be further studied.
Objective:To investigate the effect of different intrarenal pressures on perioperative complications in patients undergoing percutaneous nephrolithotomy (PCNL).Methods:The clinical data of 189 cases of complex kidney stones who underwent PCNL in General Hospital of the Southern Theater Command of the People's Liberation Army of China from August 2017 to December 2019 were retrospectively analyzed. According to the intraoperative pressure measurement in the renal pelvis, the patients were divided into instant high pressure group, transient high pressure group and sustained high pressure group. The operation time, flushing volume, extravasation of perfusate, primary stone clearance rate and other indicators of patients in each group were analyzed; postoperative conditions of patients were compared and analyzed: postoperative fever, incidence of septic shock, postoperative Hb, HCT, Na+ decrease degree, postoperative blood WBC, PCT elevation and so on.Results:There were significant differences in the extravasation of perfusate among the three groups, among which the instant high pressure group (8%) < transient high pressure group (18.4%) < sustained high pressure group (22.6%) (P< 0.05). The incidence of postoperative fever and septic shock, the degree of postoperative, HCT, Na+ decline, and the postoperative blood WBC and PCT elevations were statistically different among the three groups: instant high pressure group [20.69%, 2.30%, (0.09±0.01), (9.3±0.6), (2.6±0.2), (2.1±0.4)]< transient high pressure group [28.57%, 6.12%, (0.13±0.01), (12.3±0.9), (3.3±0.4), (5.2±1.7)]< sustained high pressure group [45.28%, 11.32%, (0.16±0.01), (13.8±0.9), (5.1±0.5), (9.8±1.8)] (P<0.05).Conclusion:Long-term maintenance of high pressure in the renal pelvis during percutaneous nephrolithotomy can significantly increase the incidence of perioperative complications.
女性盆底功能障碍（pelvic floor dysfunction，PFD）指女性盆底的肌肉、韧带、结缔组织等支持结构因创伤、退化等因素导致缺陷或松弛而出现的一类疾病，以压力性尿失禁（stress urinaryincontinence，SUI）、性功能障碍（sexual dysfunction，SD）和盆腔器官脱垂（pelvic organ prolapse，POP）为主要表现，严重影响女性日常生活[1]。年龄、妊娠、分娩方式、肥胖等均是其常见的诱发因素[2]。据报道，欧洲女性产后盆底功能障碍的发病率达64%，我国大约是48.79%[3-4]。较高的发病率以及对生活质量的严重影响使得PFD的预防、诊断和治疗显得尤为重要。随着大数据和云计算能力的提升，人工智能（artificial intelligence，AI）技术已经被广泛应用在医学领域，如疾病监测、早期筛查、风险预测、支持诊断等[5]。本文旨在总结AI在PFD的最新研究进展及应用前景，为相关研究者提供参考。
Objective:To contruct a core knowledge system for the training of specialized nurses in Urology and provide a reference for the training of specialized nurses in Urology.Methods:Guided by improving the core competence of Urology specialized nurses, the draft of the core knowledge system for Urology specialized nurses training was drawn up, through literature review, group discussions, combined with development of pecialty, specialized nurses training experiences and other methods. The Delphi method was used to conduct 2 rounds of letter inquiries to 25 experts.Result:The questionnaire response rates in the 2 rounds of letter inquiries were 100% and 96% respectively. The arithmetic mean of the evaluation results of various indicators was 4.17-5.00. The full score frequency was 32% and 100%. The level sum was 100-125. The authority coefficient was 0.938 and 0.946. Expert opinion harmony coefficients were 0.182 and 0.209 respectively (P<0.001). The ultimately formed core knowledge system for urology specialized nurses training includes 7 first level indicators and 48 second level indicators. And it was applied to the third urology specialized nurses training. After the training, the total score of nurses' core abilities was (95.6±13.4), which was significantly improved compared to before the training (P<0.05)Conclusions:The core knowledge system of Urology specialized nurses training constructed by Delphi method is scientific, authoritative, practical and effective. It can provide theoretical and practical basis for standardized and homogeneous training of Urology specialized nurses.
Objective:To explore the clinical safety and efficacy of 4.8 F visual micro-percutaneous nephrolithotomy for the treatment of renal microlithiasis of aircrew.Methods:From March 2017 to September 2021, 4.8 F visual micro-percutaneous nephrolithotomy were performed to treat renal microlithiasis of 28 cases in Armed Police Forces Hospital of Henan, which underwent flexible ureteroscopy without success, it was difficult to place the guide sheath because of ureteral stricture in 19 cases, or no stones were found in 9 cases. Then, retrograde surgical method was perfromed and patients were placed in lithotomy position, then turned to the prone position to complete the operation.Results:All 28 cases were operated successfully in one stage. Mean operative time was (18.5±6.5) min. Hemoglobin decreased by 1.2-3.5 g/L, with an average of (2.6±0.5) g/L, 2 hours after operation. One patient had postoperative severe gross hematuria, after expectant treatment the patient got better. Followed up 3 days after operation, there was no serious complication such as pleural effusion, perirenal effusion or peripheral organ injury. All patients discharged average was (3.6±0.7) d after operation. Followed up 1 month after operation, the renal CT showed no residual stones. Followed up 3 and 6 month after operation, color Doppler ultrasonography showed no recurrence of stones.Conclusion:4.8 F visual micro-percutaneous nephrolithotomy-treatment is safe and effective in the treatment of renal microlithiasis of aircrew, especially when flexible ureterosopic lithotripsy fails, it can be tried.
Objective:To investigate the feasibility of thulium laser bladder tumor resection using cystoscopy under local anesthesia (urethral mucosal anesthesia) or no anesthesia in elderly patients with high risk of anesthesia, and to find an appropriate and effective treatment method for these special patients.Methods:Between June 2020 and January 2022, 12 elderly patients in the Second Hospital of Tianjin Medical University with bladder cancer accompanied with severe comorbidity underwent thulium laser transurethral resection of bladder tumor using a flexible cystoscope under local anaesthesia. Preoperative assessment of intraoperative and post-operative risk using anesthesia classification standard, Essen stroke risk scale, exercise tolerance, revised cardiac risk index and cardiac complication rate, and crude prediction of post-operative recovery and surgical value using Karnofsky performance functional status scale, age-adjusted charlson comorbidity index score and the frailty screening scale, the status of patients were assessed immediately after surgery. Patients were assessed for tolerance by the numerical rating scale immediately intraoperatively, while the data of the duration of urinary catheter retention, postoperative hospital stay and complications were collected postoperatively. The patients were followed to January 2023 or disease recurrence.Results:All patients had no intraoperative obturator nerve reflexes or bladder perforationm, no persistent bladder bleeding or bladder tamponade postoperatively. Immediate pain scores ranged from 0-7 with a mdian of 2. All patients tolerated the procedure with less pain, the median duration of postoperative urethral catheterization was 2 days. The median postoperative hospital stay was 2 days. Twelve patients were followed up regularly with a follow-up period of 3-19 months; one patient was lost, one patient recurred 5 months after surgery and one patient recurred 13 months after surgery.Conclusions:It's a relatively safe and effective way of treating high-risk patients with bladder cancer who are at high risk of anaesthesia by ThuLRBT under local anaesthetic using a flexible cystoscope, with few complications, good patient tolerance and satisfactory recent outcomes.
Objective:To explore the application value of 3D reconstruction imaging based on CT images in laparoscopic adrenalectomy for large adrenal tumors.Methods:A retrospective analysis was performed on 12 patients with large adrenal tumor from June 2019 to August 2021 in Inner Mongolia Autonomous Region People's Hospital. The mean age of patients was (46±14) years old, and the median tumor diameter was 7.40(6.72, 8.27) cm. All patients underwent post-analysis and 3D reconstruction according to enhanced CT medical 3D image data processing software. After preoperative preparation, laparoscopic retroperitoneal resection was performed in 9 cases and laparoscopic transperitoneal resection in 3 cases.Results:12 cases of tumors were found to be located in retroperitoneum during operation, including 3 cases on the left side and 9 cases on the right side. The spiral CT 3D imaging was consistent with the intraoperative situation. All 12 patients underwent operation, the mean operative time was (168±19) min, the median intraoperative blood loss was 105(80, 167) ml, no accessory injury of important organs or large vessels, and no conversion to open surgery.Conclusions:For large retroperitoneal tumors, spiral CT 3D imaging can make surgeons fully understand the relationship between tumors and surrounding organs and blood vessels, reduce intraoperative bleeding and accessory injury, improve the success rate of laparoscopic resection and the safety of surgery.
精囊结石在泌尿系疾病中较少见，患者常因血精或射精疼痛来院就诊而发现，精囊结石体积普遍较小，桓台县人民医院接诊一例膀胱结石合并精囊多发结石的患者，成功进行手术治疗，效果良好，现报道如下。
Objective:To explore the risk factors of prolonged operation time and higher intraoperative blood loss of retroperitoneal laparoscopic radical nephrectomy (LRN).Methods:The data of patients who underwent retroperitoneal LRN from August 2010 to December 2021 were analyzed retrospectively. Demographic and hospital admission data were collected from these patients with complete medical records. Furthermore, univariate and multivariate logistic analysis were performed to determine the risk factor related to prolonged operation time and increased blood lose following LRN. Receiver operating characteristic (ROC) curve was used to assess the value of risk factors for predicting prolonged operation time and high intraoperative blood loss.Results:A total of 22 patients (24.4%) had prolonged operation time, and 14 patients (15.6%) had high intraoperative blood loss. The risk factor associated with prolonged operation time in a multivariate analysis was surgical experience (OR=0.13, P<0.001). The area under the ROC curve was 0.759 (95% confidence interval: 0.638-0.880) in the multivariate logistic regression model for predict prolonged operation time. Those associated with high intraoperative blood loss were surgical experience (OR=0.25, P=0.032) and tumor T stage (OR=3.18, P=0.007). The area under the ROC curve was 0.769 (95% confidence interval: 0.627-0.910) in the multivariate logistic regression model for predict high intraoperative blood loss.Conclusions:Surgical experience and tumor T stage were associated with the risk of prolonged operation time and high intraoperative blood loss.
Objective:To investigate the clinical efficacy, advantages and disadvantages of laparoscopic and open discontinuous pyeloplasty (Anderson-Hynes) in the treatment of pediatric ureteropelvic junction obstruction (UPJO).Methods:The data of 77 UPJO children (<14 years old) in the Second Affiliated Hospital of Kunming Medical University was retrospectively analyzed, including 43 cases of laparoscopic Anderson-Hynes operation (LP group) and 34 cases of open Anderson-Hynes operation (OP group) ). The general information of the two groups, the length of operation, the amount of intraoperative blood loss, the total amount of perinephric drainage, postoperative antibacterial drug use rate, postoperative analgesic drug use rate, postoperative complications, recent hydronephrosis relief rate, and postoperative length of hospital stay, hospitalization expenses, and surgical success rate were compared.Results:All the children's operations were successfully completed, and there was no conversion to other methods or other treatments. There were no statistically significant differences in the preoperative general data, postoperative antimicrobial drug use, postoperative complications, recent hydronephrosis relief rate, and surgical success rate between the two groups (P>0.05). In LP group, the intraoperative blood loss, the total amount of perinephric drainage, the average length of stay after surgery, and the use of postoperative pain medications were all lower than those of the OP group, while the length of operation and hospitalization costs were higher than those of the OP group, and the difference was statistically significant (P<0.05).Conclusions:Laparoscopic Anderson-Hynes operation is safe and effective for the treatment of pediatric UPJO. Compared with traditional open surgery, laparoscopic surgery has less trauma, less blood loss, faster postoperative recovery, and shorter hospital stay. With the increasing popularity of laparoscopic surgery, laparoscopic Anderson-Hynes surgery is worthy of being the recommended procedure for pediatric UPJO.
Objective:To investigate the quantitative evaluation and subjective analysis of multiplexed sensitivity-encoding diffusion weighted imaging (MUSE-DWI) versus single-shot echo-planar diffusion weighted imaging (SS-DWI) in prostate cancer (PCa).Methods:MUSE-DWI and SS-DWI images of 146 pathologically confirmed PCa patients in the Third Affiliated Hospital of Sun Yat-sen University was performed to quantify the signal to noise ratio (SNR), contrast signal to noise ratio (CNR), apparent diffusion coefficient (ADC) and subjective evaluation of the two sequences were quantitatively analyzed retrospectively.Results:The SNR and CNR of MUSE-DWI were significantly higher than those of SS-DWI (38±13) vs (18±7), (43±24) vs (18±7), the differences were statistically significant (P<0.001); the ADC values of MUSE-DWI and SS-DWI were (0.75 ±0.14) vs (0.74±0.13), respectively, P=0.020. The subjective scores were in high agreement between the two physicians, with kappa values of 0.764 (MUSE-DWI) and 0.691 (SS-DWI), respectively. Total MUSE-DWI image scores (229.0±5.7) were higher than SS-DWI (127.0±5.2); MUSE-DWI image scores were higher than SS-DWI [(3.7±3.4) vs (2.1±1.0), P<0.05].Conclusions:Compared with SS-DWI, MUSE-DWI has clearer images, higher SNR and CNR for detecting PCa, and higher subjective physician scores, which are valuable to assist clinical diagnosis and treatment of PCa.
Objective:To compare the safety and effect of breaststroke position and traditional prone position of percutaneous nephrolithotomy (PCNL) in the treatment of upper urinary tract calculi.Methods:The clinical data of 147 patients with renal calculi or upper ureteral calculi who underwent PCNL surgery in the Fifth Affiliated Hospital of Sun Yat-sen University from June 2019 to June 2020 were analyzed retrospectively. According to the different surgical positions during the operation, the patients were divided into the breaststroke position group and the traditional prone position group. The distance from the lower edge of the left twelfth rib to the lowest edge of the kidney, the distance from the back of the waist to the posterior edge of the kidney, the time to establish the channel, the operation time, the rate of multi-channel, the incidence of complications and the stone removal rate were compared between the two groups.Results:Compared with the traditional position group, in the breaststroke position group, the distance from the lower edge of the 12th rib to the lowest edge of the kidney was longer (P=0.006), the distance from the body surface of the back of the waist to the plane of the posterior edge of the kidney was shorter (P=0.020), the time to establish the channel was shorter (P<0.001), the operation time was shorter (P=0.031), and the rate of multi-channel was lower (P=0.027). There were no significant differences in stone clearance rate (P=0.751), complication rate (P=0.109), and total length of hospital stay (P=0.188) between the two groups.Conclusion:In the treatment of upper urinary tract calculi, the breaststroke position can improve the efficiency of PCNL.
广东省医学会泌尿外科学分会疑难病例多学科联合诊疗（multidisciplinary treatment，MDT）在林天歆主任委员倡导下举办已成功举办了十一期。会议从多学科、多角度详细剖析每一个泌尿系疑难病例，结合MDT各学科疾病诊治新进展对病例中存在的疑难和争议问题展开高质量、多维度的讨论。进而在为每一例疑难病例提供最佳治疗方案的同时也为参会医师了解泌尿外科领域前沿诊治理念和技术提供了平台。该项学术活动必将进一步提高和开拓我省泌尿外科青年和基层医师的诊治水平和个人视野，助力我省泌尿外科整体诊疗水平高质量发展！
【视频简介】复杂性肾结石主要指多发性肾结石和鹿角形肾结石等外科治疗棘手的病例。EAU及CUA指南明确指出经皮肾镜碎石取石术（percutaneous nephrolithotomy，PCNL）是复杂性肾结石首选外科治疗方案，但其结石清除率较低及围手术期并发症发生率较高[1-4]。随着科技的进步，逆行肾内手术（retrograde intrarenal stone surgery，RIRS）相关技术、设备快速发展，RIRS以创伤小、低风险等优势逐渐成为上尿路结石内镜手术的主要趋势。但RIRS在指南中仅被推荐为复杂性肾结石的二线治疗方案[4]。如何及时清除结石碎片、维持肾内低压、保持术中视野清晰、提高清石效率等问题是RIRS挑战复杂性肾结石必须逾越的障碍。近年来国内外学者开展了诸多研究探索。一次性电子软镜的直径比传统软镜小，术中视野更清晰，术者操作更灵活，术中联合应用负压吸引设备可降低软镜手术的风险，提高手术的舒适度，这使得该技术快速得到推广应用。随着脉宽可调钬激光、摩西激光、超脉冲光纤铥激光等新型碎石设备的出现，其碎石效率得到进一步提升[5-6]。这些内窥镜及碎石工具的革新使得我们有勇气去探索：如何通过逆行的途径处理更大、更复杂的结石。本视频分析了现阶段逆行入路治疗复杂肾结石存在的困境，介绍了一种用于治疗复杂肾结石的新型双镜联合手术，结合了负压吸引技术的逆行硬镜联合软镜取石术[7-8]。通过回顾分析多中心的347例患者数据，发现其一期结石清除率达到81.3%，其中多发肾结石的一期清石率可以达到83.8%，围术期仅1例患者发生了Ⅲ级并发症，证实了逆行入路硬镜联合软镜处理复杂性肾结石是安全有效的[9]。视频中还介绍了激光碎石的原理，结合文献及手术视频汇报了国产超脉冲光纤铥激光（sTFL）碎石的一期临床研究数据，结果显示，sTFL产生的结石碎屑直径更小，碎石过程中结石位移少，碎石时误触黏膜不渗血，这些特点使得其效率大大提升[5]。在压力反馈型灌注平台、负压吸引技术以及新型高效碎石设备的助力下，复杂性肾结石的外科治疗或将迎来新的变革。
上尿路尿路上皮癌（upper tract urothelial carcinoma，UTUC）包括肾盂癌和输尿管癌，在欧美国家其发病率较低，约占尿路上皮癌的5%~10%[1-2]，在我国其发病率较高，占尿路上皮癌的18%[3]。UTUC标准手术方法是根治性肾输尿管全长切除加膀胱袖套状切除术（radical nephrourotertectomy，RNU），但术后常出现膀胱肿瘤复发，影响预后。膀胱灌注化疗对减少膀胱肿瘤复发具有重要作用，但灌注方案尚未达成统一意见，本文就其研究进展综述如下。
Objective:To compare the effects of ureteroscopy with negative pressure suction combined with flexible ureteroscopy and percutaneous nephrolithotomy for the treatment of complex renal stones.Methods:The data of patients with complex kidney stones in Houjie Hospital of Dongguan from January 2020 to December 2022 were retrospectively collected, and were divided into two groups with 48 cases each after 1:1 propensity score matching of stone size. The study group underwent ureteroscopy with negative pressure suction combined with flexible ureteroscopy, while the control group underwent percutaneous nephrolithotomy. The comparison included assessments of stone diameter, postoperative stone clearance rate, pre- and postoperative renal function, changes in serum inflammatory factor levels, and postoperative complication rates.Results:Comparison between the study group and the control group: The stone diameter was (23.9±2.9) mm vs (24.4±3.0) mm, P=0.399; the stone clearance rate was 95.83% vs 81.25%, P=0.025; the intraoperative blood loss was (10.4±3.0) ml vs (61.2±10.1) ml, P<0.001; the postoperative CRP level was (13.1±1.4) mg/L vs (16.5±1.5) mg/L, P<0.001; the postoperative PCT level was (0.586±0.145) ng/ml vs (0.855±0.149) ng/ml, P<0.001; the total perioperative complication rate was 4.17% in the study group and 22.92% in the control group, P=0.025, with 1 case of ureteral injury in the study group, which recovered after placement of a ureteral stent. One-year postoperative follow-up revealed no cases of ureteral stricture in the study group.Conclusions:The combination of ureteroscopy with negative pressure suction and flexible ureteroscopy for the treatment of complex renal stones improved stone clearance rates, reduced surgery-induced inflammatory reactions, minimized kidney damage, and resulted in fewer complications. The efficacy was superior to that of percutaneous nephrolithotomy.
Objective:To investigate the feasibility and effectiveness of the mpMRI-TRUS-guided cognitive fusion targeted prostate biopsies combined with systematic biopsies in the diagnosis of prostate carcinoma.Methods:A prospective and randomized study of 111 patients who underwent prostate biopsy for the first time in Yangjiang People's Hospital from March 2020 to March 2022 randomly assigned into two groups, with 56 cases in observation group and 55 cases in control group. The observation group adopted mpMRI-TRUS-guided cognitive fusion targeted prostate biopsies combined with systematic biopsies, whereas the control group performed 12-needle systematic biopsies. The differences of overall puncture positive rate, the detection rate of clinically significant prostate cancer, the rate of missed diagnosis, the positive rate of single core, the tumor tissue length of specimen, the tumor proportion of specimen, postoperative complications and the cases of pathological upgrading after secondary puncture, transurethral enucleation or radical resection were compared between the two groups.Results:There were no significant differences in age, the positive rate of digital rectal examination,prostate volume, prostate-specific antigen (PSA), the cores of biopsies, PI-RADS scores and postoperative complications between the two groups. However, in the observation group, the overall puncture positive rate (50.0% vs 27.3%, P=0.014), the detection rate of clinically significant prostate cancer (50.0% vs 25.5%, P=0.008) and the positive rate of single core (26.8% vs 16.0%, P<0.001) was significantly higher than the control group. Moreover, the observation group showed longer tumor tissue length of specimen [(8±4) mm vs (4±3) mm, P=0.001], higher tumor proportion of specimen [(64.5±20.7)% vs (40.0±23.8)%, P=0.002], lower missed diagnosis rate (0% vs 25.0%, P=0.021), and less pathological upgrading cases after secondary puncture, transurethral enucleation or radical resection (0 vs 8, P=0.009).Conclusions:The mpMRI-TRUS-guided cognitive fusion targeted prostate biopsies combined with systematic biopsies can significantly improve the overall puncture positive rate and the detection rate of clinically significant prostate cancer, reduce the rate of missed diagnosis and the cases of pathological upgrading after secondary puncture, enucleation or radical resection, while the operation is simple, convenient, safe and suitable for clinical promotion.
