Background:Up to now, there is no perfect indicator to evaluate the renal function of severe hydronephrosis, which poses difficulties in the selection of clinical treatment decisions. This study investigates the role of neutrophil gelatinase-associated lipocalin (NGAL) in urine drained from the nephrostomy tube shortly after nephrostomy to evaluate the renal function of patients with severe hydronephrosis caused by ureteral obstruction. Methods:The clinical data, and blood and urine samples of 24 patients with severe hydronephrosis due to ureteral obstruction were retrospectively collected. The NGAL in the urine drained from the nephrostomy tube on the morning of the first day after the procedure was measured. The glomerular filtration rate (GFR) was determined using a nuclear scan, and the clearance rate of creatinine was calculated based on nephrostomy drainage. The correlation between the NGAL level, urine volume post-nephrostomy, affected side GFR, and creatinine clearance rate (Ccr) was assessed. Moreover, the relationship between the urinary NGAL levels and prognosis was analyzed based on whether the patients underwent nephrectomy. Results:There was a significant correlation between the urine NGAL from the nephrostomy of the affected side and the Ccr and urine volume post-nephrostomy (both P<0.05). Compared with the patients in the kidney preservation group, those who underwent nephrectomy had significantly increased NGAL levels, and significantly reduced Ccrs and nephrostomy drainage urine output. Through the receiver operating characteristic (ROC) curve evaluation, the efficacy of NGAL in predicting nephrectomy was found to be superior to both the Ccr and urine output, with an area under the curve (AUC) of 0.845. Conclusions:The NGAL in the urine shortly after nephrostomy may indicate severe renal functional deterioration.

Objective: Ureteral lesions caused by impacted ureteral stones are likely to result in postoperative ureteral stricture. On this basis, the study aimed to investigate if dual-energy spectral computed tomography can predict ureteral hardening caused by impacted stones and to explore the relationship between different types of ureteral lesions and the risk of ureteral stricture.Methods: This prospective study collected data of 93 patients with impacted stones from hospital automation system during January 2018 to October 2019. They underwent an abdominal scan on a dual-energy spectral computed tomography. During surgery, the operator used ureteroscopy to identify ureteral lesions, which were classified into four categories: edema, polyps, pallor, and hardening. Seven months later, 90 patients were reviewed for the degree of hydronephrosis.Results: Endoscopic observations revealed 38 (41%) cases of ureteral edema, 20 (22%) cases of polyps, 13 (14%) cases of pallor, and 22 (24%) cases of hardening. There were significant differences in hydronephrosis, the period of impaction, the calcium concentration of the ureter, and the slope of the spectral Hounsfield unit curve between the four groups. After that, we evaluated the factors associated with ureteral hardening and found that the calcium concentration of the ureter and hydronephrosis remained independent predictors of ureteral hardening. Receiver operating characteristic curve analysis showed that 5.3 mg/cm(3) calcium concentration of the ureter is an optimal cut-off value to predict ureteral hardening. The result of follow-up showed that 80 patients had complete remission of hydronephrosis, with a completeremission rate of 61.9% (13/21) in the hardening group and 97.1% (67/69) in the non-hardening group (p<0.001).Conclusion: Calcium concentration of the ureter is an independent predictor of ureteral hardening. Patients with ureteral hardening have more severe hydronephrosis after ureteroscopic lithotripsy. When the calcium concentration of the ureter is less than 5.3 mg/cm(3), ureteral lesions should be actively treated.(c) 2023 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

This study explored a new model of Prostate Imaging Reporting and Data System (PIRADS) and adjusted prostate-specific antigen density of peripheral zone (aPSADPZ) for predicting the occurrence of prostate cancer (PCa) and clinically significant prostate cancer (csPCa). The demographic and clinical characteristics of 853 patients were recorded. Prostate-specific antigen (PSA), PSA density (PSAD), PSAD of peripheral zone (PSADPZ), aPSADPZ, and peripheral zone volume ratio (PZ-ratio) were calculated and subjected to receiver operating characteristic (ROC) curve analysis. The calibration and discrimination abilities of new nomograms were verified with the calibration curve and area under the ROC curve (AUC). The clinical benefits of these models were evaluated by decision curve analysis and clinical impact curves. The AUCs of PSA, PSAD, PSADPZ, aPSADPZ, and PZ-ratio were 0.669, 0.762, 0.659, 0.812, and 0.748 for PCa diagnosis, while 0.713, 0.788, 0.694, 0.828, and 0.735 for csPCa diagnosis, respectively. All nomograms displayed higher net benefit and better overall calibration than the scenarios for predicting the occurrence of PCa or csPCa. The new model significantly improved the diagnostic accuracy of PCa (0.945 vs 0.830, P < 0.01) and csPCa (0.937 vs 0.845, P < 0.01) compared with the base model. In addition, the number of patients with PCa and csPCa predicted by the new model was in good agreement with the actual number of patients with PCa and csPCa in high-risk threshold. This study demonstrates that aPSADPZ has a higher predictive accuracy for PCa diagnosis than the conventional indicators. Combining aPSADPZ with PIRADS can improve PCa diagnosis and avoid unnecessary biopsies.

目的 探讨血中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、尿NGAL、血清胱抑素C(Cys-C)以及血清肌酐(Scr)预测肾移植受者发生肾功能延迟恢复(DGF)的价值.方法 收集159肾移植受者的临床资料及血液、尿液标本,根据是否发生DGF,分为DGF组(42例)和即刻肾功能恢复(IGF)组(117例).分析两组受者的临床资料,对比两组受者的血NGAL、尿NGAL、Cys-C及Scr变化情况,分析不同指标对DGF的早期预测价值.结果 159例肾移植受者中,42例发生DGF,发生率为26.4％.两组供者年龄、供肾冷缺血时间及补体依赖淋巴细胞毒性试验(CDC)比较,差异有统计学意义(均为P<0.05).DGF组血NGAL在术后2周内均高于IGF组(均为P<0.05);DGF组Cys-C、Scr、尿NGAL在术后3周内均高于IGF组(均为P<0.001).血NGAL、尿NGAL、Cys-C和Scr对肾移植受者发生DGF具有一定预测价值,其中Cys-C预测价值最高,截取值为4.73 mg/L,灵敏度为0.833,特异度为0.812,曲线下面积(AUC)为0.895.结论 Cys-C早期预测肾移植受者发生DGF的价值高于血NGAL、尿NGAL及Scr.

近年来,由于输尿管软镜技术的迅速发展以及高清晰度的电子输尿管软镜的应用,使得先前适合体外冲击波碎石(ESWL)治疗的肾结石和输尿管上段结石病例,相当一部分被输尿管软镜钬激光碎石术替代.但是,相对于输尿管软镜钬激光碎石术,ESWL仍然具有较高的结石清除率、并发症少和治疗费用低等优势.因此,欧洲泌尿外科学会(EAU)2020版泌尿系结石指南以及中华医学会泌尿外科学分会(CUA)2019版泌尿系结石诊断与治疗指南均推荐,ESWL作为直径＜2.0cm肾结石和直径＜1.0 cm输尿管结石的首选治疗方案.

Purpose:This study aimed to compare the detection rate of prostate cancer (PCa) between targeted biopsy and systematic biopsy.Patients and Methods:A total of 671 patients who underwent both targeted biopsy and systematic biopsy were included in this study. The stratified analysis was conducted based on Prostate Imaging Reporting and Data System (PIRADS) scores, region of interest load (ROI-load).Results:There was no statistical difference in the detection rate of PCa patients between systematic biopsy and targeted biopsy (44.41% vs 45.6%, P>0.05), while the detection rate of targeted biopsy in clinically significant PCa (csPCa) patients was slightly higher than that of systematic biopsy (40.83% vs 38.15%, P=0.033). Stratified analysis indicated that targeted biopsy was more advantageous in csPCa patients with PIRADS score ≥ 4 and ROI-load > 5%. The comparison of diagnostic sensitivity of systematic biopsy and targeted biopsy demonstrated that targeted biopsy was more sensitive than systematic biopsy to diagnose PCa (Z=2.110, P=0.035) at ROI-load ≤ 5%. In addition, ROI-load may be a better targeted biopsy indicator than ROI diameter for the diagnosis of PCa (Z=2.168, P=0.030).Conclusion:MRI/US fusion targeted biopsy may be more suitable for PCa detection than systematic biopsy in patients with low ROI-load.

作为生活中的美容水果,柠檬受到越来越多时尚女性的欢迎,柠檬是一种营养和药用价值都极高的水果.柠檬含有丰富的柠檬酸,被誉为"柠檬酸仓库".除此之外,柠檬还含有钙、磷、铁及维生素 B1、维生素 B2、维生素C 和烟酸等.

Background Traditional surgical methods have high complication rate and large injury in the resection of adult polycystic kidney. We investigated the effect of retroperitoneal laparoscopic resection of adult polycystic kidney assisted by arterial embolization. Methods The data of adult polycystic kidney patients who underwent laparoscopic surgery assisted by arterial embolization from November 2015 to November 2018 in our hospital were retrospectively analyzed, and the data of patients who underwent open surgery during the same period were collected. The basic data, surgical conditions, postoperative recover situation, and complications of the two groups were compared. Results There was no significant difference in the basic situation between the laparoscopic operation group and open operation (control) group. The bleeding volume, hospitalization time, and the length of incision in the laparoscopic operation group were significantly better than those in the open operation (control) group, but the operation time was significantly longer than that in the open operation group. There was no significant difference in drainage tube extraction time, bed rest time and blood transfusion rate between the two groups. There was no significant difference in the complication rate between the two groups. Conclusions Arterial interventional embolization-assisted retroperitoneal laparoscopy is an effective method for the resection of polycystic kidney.

目的 提高对肾结石合并肾盂癌的诊治水平.方法 回顾性分析2010年12月至2020年5月苏州大学附属第一医院泌尿外科收治的23例病理检查确诊为肾结石合并肾盂肿瘤的患者资料.男16例,女7例,中位年龄61岁,临床表现为血尿16例,腰痛9例.23例患者均常规行泌尿系B超或尿路平片检查,术前诊断为肾结石合并肾盂肿瘤的21例患者均行全腹增强CT或MR检查,术前诊断为肾结石的2例患者仅行平扫CT,其中输尿管镜术中诊断为肾盂肿瘤1例,术后因经皮肾伤口肿块行肿块切除病理确诊1例.9例患者术前均行尿细胞学检查,见可疑肿瘤细胞4例.23例患者均行手术治疗,其中15例行诊断性输尿管镜检查.结果 病理诊断为鳞状细胞癌2例,尿路上皮癌伴鳞状分化1例,胚胎性横纹肌肉瘤1例,黏液腺癌1例,尿路上皮癌16例,尿路上皮癌合并伤口种植2例.术后16例患者行放化疗或免疫治疗.中位随访时间50(1～104)个月.4例膀胱内肿瘤复发,6例死亡,其中5例死于肿瘤进展,1例死于心脏疾患.结论 对于肾结石病史长、既往有多次肾结石手术史、结石负荷大、合并上尿路梗阻和感染、严重血尿的患者,应考虑合并肾盂癌可能,应完善尿细胞学检查及尿液肿瘤标记物检测,完善肾脏增强CT或MR检查.术中发现合并肾盂肿瘤,应一期行根治性肾输尿管切除术.术后发现合并肾盂肿瘤者,应尽早行挽救性综合治疗.

Objective:To evaluate the application of multiparametric MRI (mpMRI)-transrectal ultrasound (TRUS) fusion guided biopsy in the diagnosis of clinical significant prostate cancer (PCa).Methods:A prospective analysis was performed in 168 patients with suspected PCa from September 2015 to June 2017 in the First Affiliated Hospital of Soochow University. Suspicious areas on mpMRl were defined and graded using prostate imaging reporting and data system version 2 (PI-RADS V2) score. All the patients had the TRUS-guided systematic biopsy, 108 patients with PI-RAD V2 scores ≥ 3 had additional MRI-TRUS targeted biopsies. Taking pathologic results as golden standard, the detection rates were compared between the 2 methods using χ 2 test. Results:Initially, all of the 168 patients underwent TRUS biopsy. PCa was detected in 86 (101 niduses) of 168 patients (51.19%, 86/168), 82 (91 niduses) (48.81%, 82/168) were not prostate cancer. Seventy eight (46.43%, 78/168) cases of PCa were detected by TRUS biopsy, and 63 (58.33%, 63/168) cases of PCa were detected by MRI-TRUS fusion guided biopsy, the difference was statistically significant between TRUS biopsy and MRI-TRUS fusion guided biopsy (χ 2=3.73, P=0.035). The 168 patients were biopsied with a total of 2 300 cores, including TRUS biopsy 2 016 cores and MRI-TRUS fusion targeted biopsy 284 cores. Additionally, the detection rate for per cores for MRI-TRUS fusion targeted biopsy (51.76%, 147/284) was significantly higher than that for TRUS biopsy cores (19.64%, 396/2 016) (χ 2=142.38, P<0.05). Among patients with a positive biopsy for PCa, the biopsy cores for conventional TRUS biopsy was 1 032 comparing to 214 cores for MRI-TRUS biopsy. The suspicious MRI-TRUS fusion targeted biopsy (68.69%, 147/214) detected more PCa compared with TRUS biopsy (38.37%, 396/1 032) (χ 2=66.27, P<0.05). Among patients with a positive biopsy for PCa, MRI-TRUS fusion targeted biopsy [69.74% (106/152)] detected more significant cancer cores than TRUS biopsy [54.50% (351/644) ] (χ 2=11.67, P<0.05). Conclusion:MRI-TRUS fusion biopsy combined with PI-RADS V2 increases positive rate markedly and improves the detection rate of clinical significant PCa.

肾结石和输尿管结石目前绝大多数采取微创内镜或腔镜的治疗方法,如经皮肾镜(PCNL)、输尿管镜(URS)、输尿管软镜(RIRS)和腹腔镜(LP).术后相当一部分患者出现这样或那样的不适,心里常有一些疑问.这里,根据我多年的诊治经验,谈一谈患者比较关心的几个术后问题.

Objective To investigate the diagnostic accuracy of magnetic resonance imaging and ultrasound (MRI/US) fusion targeted biopsy (TB) and systematic biopsy (SB) in the patients with prostate specific antigen (PSA) in grey area.Methods The patients who received MRI/US fusion TB and SB in the First Affiliated Hospital of Soochow University between October 2015 and March 2018 were retrospectively reviewed.Eligibility criteria included:tPSA ranged 4 to 10 ng/ml;prebiopsy MRI found at least 1 suspected lesion;no prostate-related treatment history;no prostate biopsy history.A total of 93 patients were invloved.The median age,tPSA and prostate volume were 66 (30-85) years,7.18 (4.11-9.95) ng/ml and 42.01 (14.93-119.15) ml,respectively.Prebiopsy MRI found 136 suspected lesions,with the median PI-RADS of 3 (3-5) and lesion size of 7 (3-20) mm.All patients underwent MRI/US fusion TB followed by SB.The comparison of two protocols in detecting any prostate cancer (PCa) as well as clinically significant prostate cancer (CsPCa) were analyzed.Results Cancer detection rates for PCa in TB [34.40％ (32/93)] was not different with SB [36.55％ (34/93),P =0.759].There was no significant difference in the detection rate of CsPCa between TB and SB [20.43％ (19/93) vs.24.73％ (23/93),P=0.483].A total of 1 374 biopsy cores were sampled,among which 266 were TB cores and additional 1108 were SB cores.The positive rate of TB cores [24.81％ (66/266)] was significantly higher than SB cores [9.84％ (109/1 108),P ＜0.001].Conclusions In the patients with PSA in grey area,MRI/US fusion TB achieved similar cancer detection rate compared with SB using only few biopsy cores.Therefore,TB was appropriate for patients with MRI suspicions.Moreover,combination of TB with SB can achieve the highest cancer detection rate.

Objective To evaluate histogram analysis of ADC and intravoxel incoherent motion (IVIM) for detecting the prostate cancer(PCa) in the transition zone(TZ).Methods A total of 49 patients underwent preoperative DW-MRI (b of 0-1000 s/mm2) were prospectively collected and processed by monoexponential and biexponential IVIM model for quantitation of apparent diffusion coefficients (ADCs),perfusion fraction (f),diffusivity (D) and pseudo-diffusivity (D*).Histogram analysis was performed by outlining entire tumour regions of interest (ROIs).These parameters (separately and combined in a logistic regression model) were used to differentiate lesions depending on histopathological analysis of magnetic resonance/transrectal ultrasound (MR/TRUS) fusion guided biopsy.The diagnostic ability of differentiating the PCa from BHP in TZ was analysed by ROC regression.Results Twenty-two(28 focus) cases of PCa in PZ and 26(33 focus) cases of BPH were confirmed by pathology.Mean ADC,median ADC,10th percentile ADC,90th percentile ADC,kurtosis,skewness of ADC and mean D,median D and 90th percentile D differed significantly between PCa and BPH in TZ.The highest classification accuracy was achieved by the mean ADC(0.857) and mean D(0.841).Logistic regression models based on mean ADC and mean D led to an AUC of 0.936.Conclusion Monoexponential DWI and biexponential IVIM could potentially improve the differentiation of prostate cancer in TZ,the combination of mean ADC and mean D performs better than the parameters alone in the diagnosis of PCa in TZ.

目的 :评价斜仰截石位输尿管软镜下钬激光切开内引流治疗肾囊性疾病的治疗方法与安全性.方法 :回顾性分析2013年3月 ～2018年1月间收治的32例肾囊性疾病患者的临床资料.男19例,女13例,年龄23～71岁,平均45.7岁,其中单纯肾囊肿16例,肾盂旁囊肿13例,肾盏憩室3例.囊腔平均直径为5.4 cm(4.5～11.0 cm),2例肾盏憩室合并结石,1例合并钙乳,结石平均直径为1.1 cm(0.8～1.4 cm).术前行静脉肾盂造影或CT尿路造影检查,常规留置输尿管支架两周,全麻后取斜仰截石位行输尿管软镜下钬激光切开内引流术,术中用钬激光将向肾脏集合系统膨出的菲薄囊壁或者憩室颈部切开,留置双J管持续内引流.结果 :32例均顺利完成手术,平均手术时间为52.3 min(30～85 min)、平均住院时间为5.2 d(4～7 d),无术后延迟性大出血 、尿源性脓毒血症 、输尿管穿孔 、肾功能损害等严重并发症,术后随访6～24月,25例囊腔消失,7例囊腔较术前明显缩小,其中3例肾盏憩室的囊腔均萎缩消失,症状缓解,结石钙乳均清除.结论 :在依据影像学准确评估和制定合理治疗措施的前提下,斜仰截石位输尿管软镜下钬激光切开内引流治疗肾囊性疾病是安全有效的方法.

Objective To evaluate the diagnostic value of prostate imaging reporting and data system version 1 (PI-RADS V1) and version 2 (PI-RADS V2) for detection of prostate cancer (PCa) in the transition zone (TZ).Methods Seventy-seven patients with suspicious lesions in TZ on mpMRI were scored according to the PI-RADS system (V1 and V2) before MR-TRUS fusion guided biopsy prospectively.In all of the patients with suspicious tumors,respectively at least one lesion with a PI-RADS V1 assessment category of ≥3,was selected for biopsy.Independent sample t test was used to compare scores of PI-RADS V1 and V2 between PCa and benign prostatic hyperplasia (BPH).The diagnostic performance of PI-RADS V 1 and V2 for detection of PCa in the transition zone was compared by analyzing ROC basing on the results of MR-TRUS fusion guided biopsy.Results A cohort of 77 patients was performed including 31 cases of PCa (32 cores) and 46 cases of BPH (51 cores).PCa (V1:1 1.50±2.79;V2:4.28±0.99) had significantly higher scores of both PI-RADS V1 and PI-RADS V2 than BPH(V1:7.51± 1.63;V2∶2.61 ±0.67) (P＜0.05).Using a PI-RADS V1 score cut-off ≥ 11,sensitivity and specificity in group PCa and BPH were calculated,which were 68.8％(22/32) and 96.1％(49/51) with a area under curve of 0.869;using a PI-RADS V2 score cut-off ≥4,which were 75.0％ (24/32) and 90.2％ (46/51) with a area under curve of 0.888,respectively.Conclusions PI-RADS system can indicate the likelihood of PCa of suspicious lesions in TZ on Mp-MRI.PI-RADS V2 perform better than V 1 for the assessment of prostate cancer in TZ.

Objective To evaluate the feasibility and efficacy of intra-cavity contrast enhanced ultrasound (ICCE-US) in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis.Methods From March 2016 to March 2017,ICCE-US-guided PCNL was performed in 35,patients who had kidney stones with slight hydronephrosis in 11 and without hydronephrosis in 24.The sample comprised 20 males and 15 females,including 10 with renal pelvic calculi alone,17 with renal pelvic calculi combined with renal calyx calculi,and 8 with partial staghorn calculi.Mean age was 46.8 years (ranging,28-75 years).The size of calculi ranged from 2.5 cm to 5.0 cm [mean(3.6 ± 1.2) cm].In the prone position,the preferred calyces are the posterior ones,which were enhanced by sulfur hexafluoride microbubbles (SonoVue) retrogradely injected through ureteral catheter.An 18-gauge needle was inserted toward the desirable calyx.Successful renal entry was confirmed by administration of ultrasound contrast agents into the collecting system via the needle regardless of whether spontaneous urine drainage was observed.A guidewire was passed through the needle to renal collecting system.Subsequently,the needle was removed.And the renal tract was dilated to F18-F20 size with dilators.Finally,holmium laser lithotripsy was performed through nephroscopy.Results Posterior calyces and its fornix were revealed under contrast-enhanced ultrasound in all patients.The successive access rate was 100％.The average time for establishing the access was (8 ±2.6)min (ranging 5-10 min).The mean number of needle passes was (1.5 ± 0.3) times per kidney,ranged from 1 to 3 times.Hemoglobin level averagely reduced (11.3 ± 3.7) g/ L (ranging 6-15 g/L) within 24 hours postoperatively.No major complications,such as adjacent organs injuries or collecting system perforation were observed.No blood transfusion was needed.The mean hospital stay was (5.6 ± 1.2) days (ranging 5-7 days).The stone-free rate was 91.4％ (32/35).Conclusions ICCE-US can demonstrate clearly about the posterior calyces and its fornix as well as puncture needle site by contrast enhancement in the nephrolithiasis patients with slight or no hydronephrosis.It has the potential to improve the accuracy and successive rate of puncture resulting in a decrease in the puncture-related complications.

Objective To estimate the value of transrectal ultrasound/magnetic resonance imaging (TRUS/MR) fusion targeted prostate biopsy(targeted biopsy,TB) in the biopsy naive patients.Methods Between September 2015 and September 2016,91 patients with PI-RADS ≥ 3 suspicious regions on the multiparametric magnetic resonance imaging (mpMRI) were retrospectively evaluated.The age of patients was 46-83 years (median 68).Serum PSA level before biopsy was 1.2-85 ng/ml (median 11.2 ng/ ml),in which 36 cases with PSA ＜ 10 ng/ml,30 cases 10-20 ng/ml,and 25 cases ＞ 20 ng/ml.Two-core TB using real-time virtual sonography (RVS) platform for mpMRI-suspicious lesions was followed by 12-core systematic biopsy (SB).The detection rates for any cancer (PCa) and clinically significant prostate cancer (CsPCa) were compared between TB and SB.Results The total detection rate for PCa was 57.1％,with a comparable positive rate between TB (44.0％) and SB (51.7％) groups which did not significantly differ (P =0.14).The proportion of CsPCa in TB group was higher than that in SB group (80.0％ vs.68.1％,P =0.21).In TB group,detection of PCa for grade 5 lesions was significantly higher than that for grade 3 lesions (77.1％ vs.10.3％,P ＜0.001).Detection of PCa was comparable between TB and SB groups in different regions of PSA ＜ 10 ng/ml,10 ～ 20ng/ml and ＞ 20ng/ml (27.8％ vs.36.1％,50％ vs.56.7％,60％ vs.68％,respectively).Conclusions This study revealed a similar rate of prostate cancer detection between 2-core targeted biopsy guided by TRUS/MR fusion and 12-core random biopsy in different PSA regions for no prior biopsy men.TB maybe tend to detect high proportion of CsPCa.PI-RADS is instructive to select appropriate patients for TB.

Objective To evaluate the application value of ureteral access sheath(UAS)in treating kidney stones in size 1 to 2 cm with flexible ureteroscopy(fURS).Methods Data on a total of 190 consecutive patients who underwent fURS for kidney stone in size 1 to 2 cm between September 2015 and September 2017 were retrospectively collected.In the UAS group,there were 85 males and 48 females,mean age was(52 ± 12)years(range 22-76 years),mean stone size was(1.6 ± 0.2)cm,and stone location was in the pelvis,upper pole and middle pole in 90 patients,lower pole in 28 and multiple in 15.In non-UAS group, there were 35 males and 22 females,mean age was(50 ± 15)years(range 16-83 years),mean stone size was(1.5 ± 0.1)cm,and stone location was in the pelvis,upper pole and middle pole in 38,lower pole in 12 and multiple in 7.The operation time,compli-cation and stone-free rate were compared between UAS group and non-UAS group.Results The age,sex ratio,stone size and stone location did not differ in two groups.The mean operation time were(80 ± 25)min and(75 ± 19)min(P>0.05),the inci-dence of ureteral damage was 6.0%(8/133)and 3.5%(2/57)(P>0.05),the incidence of postoperative fever was 9.8%(13/133)and 21.1%(12/57)(P=0.035),and the stone-free rate at 4 weeks postoperatively was 81.2%(108/133)and 75.4%(43/57)(P>0.05),respectively in the two groups.Conclusion This study demonstrates there is no significant difference in stone-free rate whether a UAS is used or not in the treatment with fURS for kidney stones in size 1 to 2 cm.Meanwhile,UAS does not increase the risk of ureteral injury,but decreases incidence of fever postoperatively.

AIM:To study the value of multi?slice spiral CT in differentiating minimal fat renal angiomyolipoma and renal cell carcinoma. METHODS: The multi?slice spiral CT data of 121 cases of renal tumor admitted into the First Hospital Affiliated to Suzhou University were retrospectively analyzed. The specificity and sensitivity of diagnosis were analyzed according to the area under the ROC curve of each index. RESULTS:According to the conventional method of point of interest, there was a statistically significant difference between the two groups in the average CT value after plain scanning (P<0.05), the value of Area under ROC curve is 0. 857. According to the large scale of the whole tumor, there were statistically significant differences between the 6 indexes of tumor in large scale (P<0.05). The area under the R0C curve of each index was more than 0.857. The area under the ROC curve in the top three were, in order: ①minimum value of large scale plain scanning(0.981); ②minimum value of cortical phase(0.969);③minimum value of parenchymal phase(0.913). CONCLUSION: The method for measuring CT value of whole tumor in large scale in this study can effectively improve the level of diagnosis and differentiation of renal benign and malignant tumors, especially for minimal fat renal angiomyolipoma and renal cell carcinoma. For the plain scanning of a wide range of tumors, the minimum CT value is less than or equal to-29 Hu, which can be used as a diagnostic criteria of minimal fat renal angiomyoli?poma and exclusion of renal cell carcinoma.

Objective To address the effects of osteopontin (OPN) on calcium oxalate renal calculus formation.Methods We silenced the OPN gene in rat kidney in vivo using lentivirus vector-deliverd short hairpin RNA (shRNA) targeting OPN through renal venous transduction.On the day 7 after injection with lentivirus,rats were fed on water containing 0.8％ glycol and 1％ ammonium chloride for 9 days.At the end of the experiments,the rats were killed and the kidney tissues were removed for subsequent analysis.Results The lentiviru s vector could effectively infect renal cortex and medulla tissue.OPN-shRNA transfection resulted in significant reduction in the content of OPN.Crystals recorded as the average total pixels (object area) were 20 716 ± 7 755 and 54 921 ± 3 469 in renal cortex sections in the OPN-shRNA group and negative lentivirus vector group,respectively (P ＜0.01),as well as 18 618 ± 2 285 and 30 475 ±1 735 in the medulla sections in both groups,respectively (P ＜0.01).Conclusion Specific knockdown of OPN gene in kidneys of hyperoxaluric rats leads to a decrease in OPN production and significantly inhabits calcium oxalate crystal deposition.OPN may play a certain role in promoting calcium oxalate renal calculus formation.