Background:Bladder cancer is a common malignancy of the genitourinary system. Recent studies have confirmed the existence of microorganisms in urine. This study aimed to characterize changes in the urinary microbiota of Chinese bladder cancer patients and determine differences between patients with muscle-invasive bladder cancer (MIBC) and those with non-muscle-invasive bladder cancer (NMIBC). Methods:Urine samples were collected from 64 patients with bladder cancer and 94 disease-free controls using the clean catch method and sequenced by 16S rRNA gene sequencing. Sequencing reads were filtered by VSEARCH and clustered by UPARSE. Results:Significant associations were found between urinary microbiota and factors such as sex, age, and disease status. After age adjustment, differences in beta diversity were observed between healthy men and women, cancer patients and healthy controls, and NMIBC and MIBC patients. The cancer patients had an increased abundance of 14 bacterial genera, including Stenotrophomonas, Propionibacterium, and Acinetobacter. Notably, Peptoniphilus spp. were enriched in high-risk MIBC patients, indicating their potential as a risk marker. Functional prediction via PICRUSt analysis suggested enriched metabolic pathways in specific disease groups. Furthermore, molecular ecological network analysis revealed differences based on sex and disease type. Conclusions:This significant microbial diversity indicates a potential correlation between urinary microbiota dysbiosis and bladder cancer, with implications for risk stratification and disease management. The identified urinary microbiota may serve as noninvasive markers for bladder cancer, warranting further validation in larger cohorts. This study provides a foundation for further research on the mechanisms of bladder cancer progression.

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (PD22)1 May 2024PD22-08 RESEARCH ON THE ACCURACY OF AUGMENTED REALITY GUIDED LAPAROSCOPIC SURGERY Zichen Zhao, Lei Wang, Ningchen Li, and Yanqun Na Zichen ZhaoZichen Zhao , Lei WangLei Wang , Ningchen LiNingchen Li , and Yanqun NaYanqun Na View All Author Informationhttps://doi.org/10.1097/01.JU.0001009504.18450.e0.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: In this study, we aimed to objectively quantify the accuracy of using Augmented Reality (AR) for localization and guidance in simulated laparoscopic surgery. METHODS: Ten cases of intrarenal tumors were selected, and high-accurate 3D images were generated based on the Digital Imaging and Communications in Medicine (DICOM) data of these cases. The characteristics of the ten tumors were then integrated into the kidney of one case. Urological surgeons performed preoperative planning and surgical incision design based on the tumor characteristics depicted in these 3D images. The surgical incision and tumor location were simplified by engineers into planned incision points (PPs) and tumor center points (CPs). A 3D-printed model of the kidney was created for the selected case. The 3D images were registered with the 3D-printed kidney in a laparoscopic simulator. Under the AR guidance of 3D images alone and 3D images with preoperative planning marks (3D images/marks) respectively, the tumor incisions were marked by the same surgeon and then measured and analyzed. RESULTS: The average distances between the incision locations guided by 3D images/marks and those guided solely by 3D images were 3.90 mm and 11.37 mm (p<0.01). When dividing the ten tumor locations into two groups based on their proximity to the laparoscope lens, in the group with tumors located farther from the lens, the average distances between the incision locations guided by preoperative planning marks and 3D images were 16.5 mm and 5.23 mm (p<0.05). In the group with tumors located closer to the lens, the average distances between the incision locations guided by preoperative planning marks and 3D images were 3.74 mm and 1.91 mm (p>0.05). CONCLUSIONS: AR laparoscopic guidance with preoperative planning marks provides more precise localization compared to 3D image guidance along. Due to the translucency of AR images, the accuracy of AR guidance for deep-seated tumors located farther from the laparoscope lens may be affected by perspective. Therefore, we recommend preoperative planning using 3D images and utilizing 3D images with preoperative planning marks for the resection of deep or concealed lesions (such as intrarenal tumors) during laparoscopic or robot-assisted laparoscopic surgeries. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e464 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Zichen Zhao More articles by this author Lei Wang More articles by this author Ningchen Li More articles by this author Yanqun Na More articles by this author Expand All Advertisement PDF downloadLoading ...

This study was designed to evaluate the safety and feasibility of laparoscopic radical cystectomy (LRC) for male octogenarian patients with muscle-invasive bladder cancer (MIBC). Briefly, a total of 57 male octogenarian patients (A group) with bladder carcinoma were enrolled and underwent LRC and intracorporeal pelvic lymph node dissection with bilateral cutaneous ureterostomy from May 2016 to December 2022. Besides, 63 male patients (age < 80 years old) with bladder carcinoma undergoing LRC and 17 octogenarian male patients with bladder carcinoma undergoing open radical cystectomy (ORC) were enrolled in B and C groups as control. All perioperative clinical materials and outcomes of long-term follow-up, and complication were collected. The specific results were shown as follows. Compared with C group, the operation time and resected lymph node in A group was increased, and the estimated blood loss, the number of transfusion needed, duration of pelvic drainage and hospital stay after surgery was decreased. The death rate and ileus complication rate were higher in A group (12 cases) than in C group (15 cases). The cases of ureteral stricture in A group (13 cases) was decreased compared with that in C group. Overall, LRC and bilateral cutaneous ureterostomy are safe, feasible and better choices for the treatment of male octogenarian patients with MIBC. The octogenarian receiving cutaneous ureterostomy heals slowly and exists certain incomplete intestinal obstruction after surgery.

BackgroundThe best choice of first-line treatment for metastatic hormone-sensitive prostate cancer (mHSPC) is unclear. We aimed to compare the effectiveness and safety determined in randomized clinical trials of doublet and triplet treatments for mHSPC.MethodsMedline, Embase, Cochrane Central and ClinicalTrials.gov were searched from inception through July 01, 2022. Eligible studies were phase III randomized clinical trials evaluating androgen deprivation treatment (ADT) alone, doublet therapies [ADT combined with docetaxel (DOC), novel hormonal agents (NHAs), or radiotherapy (RT)], or triplet therapies (NHA+DOC+ADT) as first-line treatments for mHSPC. Outcomes of interest included overall survival (OS), progression-free survival (PFS) and grades 3-5 adverse events (AEs). Subgroup analyses were performed based on tumor burden. The effects of competing treatments were assessed by Bayesian network meta-analysis using R software.ResultsTen trials with 12,298 patients comparing nine treatments were included. Darolutamide (DARO) +DOC+ADT ranked best in terms of OS benefits (OR 0·52 [95% CI 0·39–0·70]), but its advantages were all statistically insignificant compared with other therapy options except for DOC+ADT (OR 0·68 [95% CI 0·53–0·88]) and RT+ADT (OR 0·57 [95% CI 0·40–0·80]). In terms of PFS, enzalutamide(ENZA)+DOC+ADT (OR 0·32 [95% CI 0·24–0·44]) and abiraterone and prednisone (AAP) +DOC+ADT (OR 0·33 [95% CI 0·25–0·45]) ranked best. For patients with high volume disease (HVD), low volume disease (LVD), and visceral metastases, the optimal therapies were AAP+DOC+ADT (OR 0·52 [95% CI 0·33–0·83]), apalutamide+ADT (OR 0·52 [95% CI 0·26–1·05]) and DARO+DOC+ADT (OR 0·42 [95% CI 0·13–1·34]), respectively. For safety, AAP+DOC+ADT (OR 3·56 [95% CI 1·51–8·43]) ranked worst with the highest risk of grade 3−5 AEs.ConclusionsTriple therapies may further improve OS and PFS but may be associated with a decrease in safety. Triplet therapies could be suggested for HVD patients, while doublet combinations should still be preferred for LVD patients.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPEROFILES/303117_STRATEGY_20220202.pdf, identifier CRD4202303117.

Objective:To identify the risk factors for urinary sepsis after transurethral ureteropyeloscopic holmium laser lithotripsy (URSL).Methods:Clinical data of patients with upper urinary calculi treated by URSL at Peking University Shougang Hospital from June 2015 to December 2020 were retrospectively analyzed, and the patients were divided into either a postoperative sepsis group (21 cases) or a non-sepsis group (1086 cases) according to the development of postoperative sepsis or not. Gender, age, body mass index (BMI), diabetes, calculus location, calculus size, CT value, operation time, preoperative indwelling of ureteral stents, preoperative urinary tract infection, preoperative obstructive pyelonephritis, preoperative urine bacterial culture, and surgical methods were compared between the two groups to identify the risk factors for urosepsis after URSL.Results:A total of 1107 patients were enrolled, of whom 21 (21/1107) met the diagnostic criteria for urinary sepsis. Compared with the non-sepsis group, there were statistically significant differences in BMI, stone size, operation time, preoperative obstructive pyelonephritis, preoperative urine bacterial culture, and surgical methods in the sepsis group (P＜0.05). Multivariate Logistic regression analysis showed that operative time, preoperative obstructive pyelonephritis, and positive preoperative urine bacterial culture were risk factors for postoperative urinary sepsis (OR=1.157, 95% CI: 1.026~1.305, P=0.018; OR=4.733, 95%CI: 1.274~17.573, P=0.020; OR=5.287, 95%CI: 1.408~19.857, P=0.014).Conclusion:For patients with obstructive pyelonephritis and positive urine bacterial culture caused by upper urinary calculi before surgery, and patients with long operation time, we should be alert to the risk of urinary sepsis after URSL.

目的:探讨前列腺尖部区域全息影像精细建模的可行性和临床价值.方法:回顾性分析2021年1至12月北京大学首钢医院13例行全息影像建模及腹腔镜前列腺根治性切除术患者的临床资料.年龄(71.0±4.7)岁,PSA中位值17.4(6.19,159.6)μg/L.获取患者术前多参数MRI的DICOM数据,在冠、矢、轴三面实时比对下,精细分割、重构前列腺尖部形态及尿道外括约肌复合体.将尖部分为1型尖锐型、2型前唇突出型、3型后唇突出型和4型圆钝型,测量括约肌复合体的总长度和外露长度.尿道外括约肌复合体外露长度≤11.5mm或外露比例≤60％被定义为尿控高风险.尖部存在肿瘤病灶者均定义为尖部瘤控高风险,同时伴有不良尖部形态(1型)或癌灶侵及尖部包膜者定义为极高风险.术前根据尿控及瘤控风险制订个体化尖部处理策略,术中利用全息影像-内镜图像融合系统引导手术实施.结果:13例患者的手术均顺利完成,手术时间(177±43)min,pT分期在T3a～T4者7例.尿道外括约肌复合体总长度为(17.1±3.5)mm,外露长度为(12.2±2.6)mm,外露比例为(72.4±12.8)％.尖部形态为1～4型者分别为2例、2例、4例和5例.术前经全息影像评估为尿控低风险者7例,高风险者6例,术后6个月尿控恢复率分别为6/7(85.7％)和1/6(16.7％),术后12个月尿控恢复率分别为7/7例(100％)和5/6(83.3％).术前评估尖部瘤控为低风险者3例,高风险者8例,极高风险者2例,术后病理证实的尖部切缘阳性率分别为0/3(0％),3/8(37.5％)和2/2(100％).结论:全息影像精细重构前列腺尖部区域,有助于预估尿控和瘤控风险,为术中精细操作提供帮助.

Objective:To investigate the feasibility and accuracy of transperineal prostate targeted biopsy guided by holographic image.Methods:Clinical data of 10 patients with transperineal prostate targeted biopsy guided by holographic image in Peking University Shougang Hospital between May and September 2020 were analyzed retrospectively. The average age was (70.9±10.3) years old, the median PSA was 15.1(6.02-1110.14) ng/ml, prostate MRI were performed before biopsy and the PI-RADS scores were all ≥ 3, and the number of suspicious target lesions was 1.4±0.5. CT examinations of urinary system were performed on the premise of mild lithotomy position and positioning stickers pasted on the skin of perineum and lower abdomen. The original data of CT and MRI were obtained, holographic image models were firstly made separately and then fused into a complete model, and the puncture paths were planned for the target lesions. At the time of puncture, the patient took the same body position as in CT scan, the operator wore a mixed reality head mounted display (HoloLens glasses), and the skin positioning stickers were used for visual registration between the holographic model and the real human body. Then under the guidance of the virtual puncture path, the puncture biopsy gun was placed, fired after reaching the predetermined depth, a transrectal ultrasound probe was placed to clarify the position of the puncture needle, and the objective accuracy of puncture was judged by comparison of ultrasound and MRI images. If the first shot was judged to be inaccurate, it was allowed to make a supplementary shot after adjusting the angle. After holographic guided biopsies, cognitive fusion targeted biopsies and 12-needle systematic biopsies were performed routinely, and the proportion of positive needles of the three different biopsy methods were calculated respectively.Results:All the 10 cases were successfully completed, including 16 holographic image guided shots, 28 cognitive fusion targeted shots and 116 systematic shots. The objective accuracy of holographic image guided biopsy after first shot judgments was 68.8% (11/16), while it raised to 87.5% (14/16) after supplementary shots. The proportion of positive needles in the three puncture methods were 56.3% (9/16), 42.9% (12/28) and 19.8% (23/116), respectively ( P=0.002). The results of subjective questionnaire showed that holographic model was helpful to improve the spatial understanding of lesions. The satisfaction of intraoperative holographic registration and guided puncture were 90% and 60%, respectively. No puncture related complication occurred in this group. Conclusion:The study preliminarily confirmed the feasibility of holographic image-guided prostate targeted biopsy. This new puncture method has better objective accuracy, and the proportion of positive needles is significantly better than systematic biopsy.

Objective:To identify the influencing factors of extracorporeal shockwave lithotripsy (ESWL) in the treatment of high-density ureteral calculi (CT value > 1000 HU).Methods:Clinical data of single ureteral calculi with a CT value > 1000 HU diagnosed at Peking University Shougang Hospital from June 2015 to June 2020 were retrospectively collected, and the efficacy and influencing factors of the first external lithotriptomy were analyzed.Results:Sixty-five patients were included in the study. The average stone size was (10.63±3.24) mm, the average stone density (CT value) was 1202±126 HU, and the success rate of lithotripsis was 63.1%. Stone size was an independent factor affecting the therapeutic effect of ESWL (odds ratio=1.586, 95% confidence interval: 1.162~2.166, P=0.004). ROC analysis showed that the critical value of stone size for predicting ESWL efficacy was 1 cm.Conclusion:For ureteral calculi with a CT value＞1000 HU, stone size is an independent predictor of ESWL efficacy, and the success rate of ESWL for calculi ≤ 1 cm was 84.8%.

Current methods for the diagnosis and monitoring of bladder cancer are invasive and have suboptimal sensitivity. Liquid biopsy as a non-invasive approach has been capturing attentions recently. To explore the ability of urine-based liquid biopsy in detecting and monitoring genitourinary tumors, we developed a method based on promoter-targeted DNA methylation of urine sediment DNA. We used samples from a primary bladder cancer cohort (n=40) and a healthy cohort (n=40) to train a model and obtained an integrated area under the curve (AUC) > 0.96 in the 10-fold cross-validation, which demonstrated the ability of our method for detecting bladder cancer from the healthy. We next validated the model with samples from a recurrent cohort (n=21) and a non-recurrent cohort (n=19) and obtained an AUC > 0.91, which demonstrated the ability of our model in monitoring the progress of bladder cancer. Moreover, 80% (4/5) of samples from patients with benign urothelial diseases had been considered to be healthy sample rather than cancer sample, preliminarily demonstrating the potential of distinguishing benign urothelial diseases from cancer. Further analysis basing on multiple-time point sampling revealed that the cancer signal in 80% (4/5) patients had decreased as expected when they achieved the recurrent-free state. All the results suggested that our method is a promising approach for noninvasive detection and prognostic monitoring of bladder cancer.

OBJECTIVE:To explore the relationship between sleep habits (sleep duration, sleep efficiency, sleep onset timing) and ischemic stroke, and whether there is an interaction between sleep habits and ischemic stroke susceptibility gene loci. METHODS:A questionnaire survey, physical examination, blood biochemical testing and genotyping were conducted among rural residents in Beijing, and the gene loci of ischemic stroke suggested by previous genome-wide association studies (GWAS) were screened. Multivariable generalized linear model was used to analyze the correlation between sleep habits, sleep-gene interaction and ischemic stroke. RESULTS:A total of 4 648 subjects with an average age of (58.5±8.7) years were enrolled, including 1 316 patients with ischemic stroke. Compared with non-stroke patients, stroke patients with sleep duration ≥9 hours, sleep efficiency < 80%, and sleep onset timing earlier than 22:00 accounted for a higher proportion (P < 0.05). There was no significant association between sleep duration and risk of ischemic stroke (OR=1.04, 95%CI: 0.99-1.10, P=0.085). Sleep efficiency was inversely associated with the risk of ischemic stroke (OR=0.18, 95%CI: 0.06-0.53, P=0.002). The risk of ischemic stroke in the subjects with sleep efficiency < 80% was 1.47-fold (95%CI: 1.03-2.10, P=0.033) of that in the subjects with sleep efficiency ≥80%. Falling asleep earlier than 22:00 was associated with 1.26 times greater risk of stroke than falling asleep between 22:00 and 22:59 (95%CI: 1.04-1.52, P=0.017). Multifactorial adjustment model showed that rs579459 on ABO gene had an interaction with sleep time (P for interaction =0.040). When there were two T alleles for rs579459 on the ABO gene, those who fell asleep before 22:00 had 1.56 times (95%CI: 1.20-2.04, P=0.001) the risk of stroke compared with those who fell asleep between 22:00 and 22:59, and there was no significant difference when the number of pathogenic alleles was 0 or 1. In the model adjusted only for gender, age and family structure, sleep duration and the number of T allele rs2634074 on PITX2 gene had an interaction with ischemic stroke (P for interaction=0.033). CONCLUSION:Decreased sleep efficiency is associated with increased risk of ischemic stroke, and falling asleep earlier than 22:00 is associated with higher risk of ischemic stroke. Sleep onset timing interacted with rs579459 in ABO gene and the risk of ischemic stroke. Sleep duration and PITX2 rs2634074 may have a potential interaction with ischemic stroke risk.

目的:探讨全息影像应用于经皮肾镜碎石取石术术前规划及术中辅助穿刺的可行性和价值.方法:回顾性分析2020年5月至2022年2月北京大学首钢医院收治的30例行全息影像辅助经皮肾镜碎石取石术患者的临床资料.年龄(53.6±11.9)岁,S.T.O.N.E结石评分为7分(5～10).术前一周内行手术体位下泌尿系增强CT扫描,使用体位垫、定位贴及呼吸控制.将CT检查数据制作为全息影像模型并针对目标肾盏规划穿刺路径,术前行认知手术模拟以预估清石范围并制作经穿刺路径的"模拟超声截面图像".术中患者取与CT检查相同体位,采用混合现实头戴式显示器模式或平面查看器模式,将全息影像用于辅助术者在超声下准确、快速识别目标肾盏及明确皮肤穿刺点,进而按术前的计划实施超声引导下的精准穿刺.对手术相关数据及术后并发症情况进行记录.结果:本组30例均顺利完成,平均手术总时间及穿刺耗时分别为(93.3±32.6)min及(8.5±3.6)min.穿刺通道数目为1个(1～3),穿刺尝试次数为1次(1～3),实际穿刺通道与规划的吻合率为97.1％(34/35),完全清石率为93.3％(28/30),Clavien-Dindo并发症Ⅰ级、Ⅱ级和Ⅲ～Ⅴ级者分别为7例(23.3％)、3例(10％)和0例.结论:全息影像应用于PCNL术前规划和术中辅助穿刺具有可行性,术中通过与超声结合的多模态方式,有助于经皮肾通道的准确建立和避免严重并发症.

Objectives To establish a three‐dimensional visualization model of percutaneous nephrolithotomy, apply it to guiding intraoperative puncture in a mixed reality environment, and evaluate its accuracy and clinical value. Methods Patients with percutaneous nephrolithotomy indications were prospectively divided into three‐dimensional group and control group with a ratio of 1:2. For patients in three‐dimensional group, positioning markers were pasted on the skin and enhanced computed tomography scanning was performed in the prone position. Holographic three‐dimensional models were made and puncture routes were planned before operation. During the operation, the three‐dimensional model was displayed through HoloLens glass and visually registered with the patient's body. Puncture of the target renal calyx was performed under three‐dimensional‐image guiding and ultrasonic monitoring. Patients in the control group underwent routine percutaneous nephrolithotomy in the prone position under the monitoring of B‐ultrasound. Deviation distance of the kidney, puncture time, puncture attempts, channel coincidence rate, stone clearance rate, and postoperative complications were assessed. Results Twenty‐one and 40 patients were enrolled in three‐dimensional and control group, respectively. For three‐dimensional group, the average deviation between virtual and real kidney was 3.1 ± 2.9 mm. All punctures were performed according to preoperative planning. Compared with the control group, the three‐dimensional group had shorter puncture time (8.9 ± 3.3 vs 14.5 ± 6.1 min, P < 0.001), fewer puncture attempts (1.4 ± 0.6 vs 2.2 ± 1.5, P = 0.009), and might also have a better performance in stone clearance rate (90.5% vs 72.5%, P = 0.19) and postoperative complications ( P = 0.074). Conclusions The percutaneous nephrolithotomy three‐dimensional model manifested acceptable accuracy and good value for guiding puncture in a mixed reality environment.

Objective: To compare the efficacy and safety of a single-use digital flexible ureteroscope (FURS) and a reusable FURS for the treatment of lower pole stones (LPS) smaller than 20mm. Patients and Methods: We analyzed the data of 49 patients with LPS from our previous multicenter, randomized, open-label clinical trial in four hospitals in China. All patients underwent FURS for LPS with a single-use FURS ZebraScope (TM) (trial group) or a reusable FURS URF-V (control group). The efficacy endpoints assessed were the 1-month postsurgical stone-free rate (SFR), operative time, length of postoperative hospital stay, and mean reduction in hemoglobin level. The safety outcomes assessed were the presence of adverse events (AEs), severe AEs (SAEs), and postoperative complications. Results: The demographic and preoperative parameters were comparable between the two groups. The 1-month SFR was 84.00% for the ZebraScope group and 58.33% for the reusable flexible ureteroscope (URF-V) group (p<0.05). There was no difference between the two groups in the operative time (p=0.665), length of hospital stay (p=0.308), presence of postoperative complications (p=0.307), presence of AEs (p=0.483), and the presence of SAEs (p=0.141). Conclusions: This study demonstrates that single-use digital FURS is a safe and effective option and can offer higher SFR than the reusable FURS in the treatment of LPS smaller than 20mm. We recommend single-use digital FURS as an alternative to reusable FURS for the treatment of LPS. The Clinical Trial Registration number: ChiCTR1900021615.

Objective:To evaluate the efficacy and safety of ureteroscopic holmium laser lithotripsy(FURL) in the treatment of upper urinary calculi.Methods:The clinical data of 1074 patients who underwent FURL in the first phase from October 2010 to October 2019 in our center were retrospectively analyzed. The patient's age, gender, BMI, diabetes mellitus, distribution of stones, stone size, stone location, mean CT value, preoperative urine bacteria culture, preoperative indwelling ureteral stent and operation time were recorded, and the stone free rate (SFR) and postoperative infection rate were also counted. According to whether there was stone residue, the patients were divided into stone removal group and stone residue group. According to whether infection occurred after operation, the patients were divided into infection group and non-infection group. The correlation between preoperative clinical characteristics and SFR and postoperative infection complications was analyzed by regression analysis, and the factors affecting SFR and postoperative infection were analyzed.Results:SFR was 91.3% and postoperative infection rate was 7.4% after the first FURL in this group of patients. Multivariate regression analysis showed that the location, size, presence or absence of lower calyx calculus, preoperative indwelling ureteral stent and mean CT value were the independent influencing factors of SFR. Whether complicated with diabetes mellitus, positive urine bacterial culture before operation, bilateral upper urinary tract lithotripsy and operation time were independent risk factors for postoperative infection.Conclusions:URHL has high curative effect and safety, and can be used as one of the treatment methods for upper urinary tract calculi, which is worthy of further promotion.

Objective This study aimed to evaluate the predictors for positive biopsy in prostate cancer (PCa) patients and develop a risk-stratification score model for positive biopsy rate in patients with prostate specific antigen (PSA) in the gray zone. Methods In this retrospective, multicenter, real-world study, Chinese patients receiving prostate biopsy for the first time were included. The study evaluated the positive biopsy rate, predictors for positive biopsy and a risk prediction model for PSA 4-10 ng/mL PCa was developed. The univariate and multivariate logistic regression analyses were used to identify the risk factors. Results A total of 2426 patients were included in the study. The biopsy positive rate was 47.57%, 25.77%, and 60.57% among overall patients, total PSA (t-PSA) 4-10 ng/mL patients, and PSA > 10 ng/mL patients respectively. Elderly age 60-74, >= 75, multi parametric magnetic resonance imaging (MP-MRI), pre-operative PSA > 10 and PSA density (PSAD) significantly increased the positive rate in overall population, and elderly age, MP-MRI, positive digital rectal examination and f-PSA were significant predictors for positive biopsy in PSA 4-10 ng/mL population. A risk prediction model for positive biopsy rate in patients with PSA in the gray zone was developed. Area under curve (AUC) was associated with low accuracy for all the variables used such as tPSA (0.53), PSAD (0.57), frequency of puncture (0.53) and MP-MRI (0.64) in prediction of biopsy positive rate. Conclusion Our study evaluated the significant predicative factors for positive biopsy and the PCa risk prediction model developed might help Clinicians to avoid unnecessary biopsy in patients with PSA in gray zone.

Introduction: Dapoxetine on demand has been approved for premature ejaculation (PE) management in China; however, studies on the efficacy and safety of this treatment in the Chinese population are scarce. Aim: The aim of this study was to evaluate the safety and effectiveness of dapoxetine 30 mg and 60 mg on demand in Chinese men with PE. Methods: Phase IV real-world study on 1,252 patients with PE. If men reported no response to dapoxetine 30 mg after 4 weeks treatment, dapoxetine has been uptitrated at 60 mg for 4 weeks more. Main Outcome Measure: Self-reported data were collected for demographics, general and sexual health characteristics, PE severity, and treatment safety and effectiveness, as measured by the PE profile questionnaire. Results: Adverse events (AEs), such as nausea, thirst, headache, and dizziness, similarly to previous literature, were detected. The treatment-emergent AEs rate was higher in the patients treated with 30 and 60 mg (n = 192) compared with those treated with the dapoxetine 30 mg only (n = 1060) (34.4% vs 15.8%, respectively). No new safety concerns were observed. The overall effectiveness rates were 88.2% in subjects using 30 mg of dapoxetine, whereas a rescue from the previous failure was in 55.7% in the patients who received 60 mg after the initial 30 mg. Overall, 83.2% responded to dapoxetine at dosages equal to or lower than 60 mg. Conclusion: The results in this study demonstrated in a large Chinese population that on-demand dapoxetine is a safe and effective symptomatic treatment in patients with PE.J Peng, L Yang, L Liu, et al. Safety and Effectiveness of Dapoxetine On Demand in Chinese Men With Premature Ejaculation: Results of a Multicenter, Prospective, Open-Label Phase IV Study. Sex Med 2021;9:100296.

目的 探讨在多发转移性前列腺癌患者新辅助治疗后转移灶减少或消失的患者中,减瘤性前列腺根治性切除术(CRP)的安全性以及效果.方法 回顾性分析我院确诊的多发转移性前列腺癌行辅助治疗后转移灶减少或消失,且在2017年5月至2018年7月之间行腹腔镜CRP手术的患者共6例,随访截止至2020年6月.所有纳入研究的患者均行筋膜外途径腹腔镜根治性前列腺切除术.记录患者的术中及术后的临床指标,包括手术时间、术中出血量、术后住院时间、留置尿管时间、引流时间、术后Gleason评分、T分期、淋巴结阳性、切缘阳性、术后1个月及1年尿控、术后1个月前列腺特异性抗原(PSA)、术后辅助治疗方案、随访时间、目前PSA、以及是否发展为去势抵抗性前列腺癌(CRPC).比较术前和术后1个月PSA有无统计学意义.结果 6例患者均顺利行腹腔镜前列腺根治性切除术,无中转开放,术后均顺利拔管出院.术后病理局部晚期(≥T3b)患者达50％;33.3％的患者术后淋巴结阳性及切缘阳性;83.3％的患者术后1年达到尿控;平均随访29.5个月,有1例患者发展为CRPC.除病例3术前及术后PSA均为0外,其余5例患者术后1个月PSA均较术前有所下降,差异有统计学意义(Z=-2.019,P=0.043).结论 对于新辅助治疗后转移灶减少或消失的转移性前列腺癌患者,选择合适的病例,由经验丰富的医生实施减瘤性前列腺根治性切除术,具有安全性;减瘤性根治性前列腺切除术能否给患者带来生存获益仍需进一步的研究.

Abstract Background: To compare the efficacy and safety of a single-use digital flexible ureteroscope (FURS) and a reusable FURS for the treatment of lower pole stones (LPS) smaller than 20 mm.Methods: A prospective case-control study was conducted using the clinical data from a multicenter, randomized, open-label clinical trial in four hospitals in China. A single-use digital FURS ZebraScope™ was utilized in the trial group during surgery, with a reusable FURS URF-V used in the control group. The efficacy endpoints assessed were the 1-month postsurgical stone-free rate (SFR), operative time, length of postoperative hospital stay, and mean reduction in hemoglobin level. The safety outcomes assessed were the presence of adverse events (AEs), severe AEs (SAEs), and postoperative complications.Results: In total, 49 patients with LPS underwent surgery using FURS. The demographic and preoperative parameters were comparable between the 2 groups. The 1-month SFR was 84.00% for the ZebraScope™ group and 58.33% for the URF-V group (P<0.05). There was no difference between the two groups in the operative time (P=0.665), the length of hospital stay (P=0.308), the presence of postoperative complications (P=0.307), the presence of AEs (P=0.483)，and the presence of SAEs (P = 0.141). Conclusions: This study demonstrates that single-use digital FURS is a safe and effective option and can offer higher SFR than the reusable FURS in the treatment of LPS smaller than 20 mm. We recommend single-use digital FURS as an alternative to reusable FURS for the treatment of LPS.Trial registration: The trial was registered in Chinese Clinical Trial Registry. The registration number: ChiCTR1900021615. Date of registration: 1/3/2019. This trial was registered retrospectively.

目的 极高危非肌层浸润性膀胱癌具有很高的复发和进展风险.明确双侧髂内动脉化疗栓塞术(IAC)经尿道电切术后辅助措施的价值.方法 回顾性分析2015年1月至2017年12月收治的该类患者38例,均接受经尿道膀胱肿瘤电切术及术后规律膀胱灌注治疗(卡介苗或表柔吡星/吡柔吡星),根据是否接受IAC分为IAC组及对照组.IAC组在电切术后2周内接受第1疗程IAC,再间隔3～4周行第2疗程IAC,化疗方案:顺铂60 mg/m2,吡柔比星25 mg/m2.术后随访指标包括无复发生存时间、随访期间进展率及切除膀胱率等.结果 IAC组12例,对照组26例,平均随访时间(30.1±12.4)个月.IAC组与对照组在主要观察指标上的比较如下:无复发生存时间(20.3±14.1)个月比(8.9±7.2)个月,(P=0.002),1年无复发生存率66.7％比26.9％,(P=0.02),2年无复发生存率33.3％比7.7％,(P=0.07),随访期间进展率33.3％比46.2％,(P=0.46),切除膀胱率25.0％比46.2％,(P=0.21).结论 对于极高危非肌层浸润性膀胱癌患者,在经尿道电切术后辅助双侧髂内动脉化疗栓塞有助于延缓疾病的复发.