ABSTRACT Background Predicting clear cell renal cell carcinoma (ccRCC) pathological grade preoperatively is critical for clinical management. This study aims to evaluate the diagnostic accuracy and clinical utility of machine learning (ML)‐based imaging models. Methods The Cochrane Library, PubMed, Embase, and Scopus databases were searched systematically for studies published before January 2026. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 and the Radiomics Quality Score. Pooled sensitivity, specificity, positive/negative likelihood ratios (PLRs/NLRs), diagnostic scores, diagnostic odds ratios (DORs), and summary receiver operating characteristic (SROC) curves were calculated. Decision curve analysis (DCA) and Fagan nomogram analysis were performed to evaluate clinical utility. Subgroup analyses were conducted to further explore sources of heterogeneity. Results A total of 43 studies involving 12,675 patients were included. The area under the SROC curve was 0.89, with a sensitivity of 0.79, specificity of 0.85, PLR of 5.27, NLR of 0.25, diagnostic score of 3.07, and DOR of 21.52. Fagan analysis revealed a positive prediction increased the posttest probability of high‐grade disease to 70%, whereas a negative prediction decreased it to 10%. DCA demonstrated a net benefit over standard strategies across a 0.10–0.70 threshold range. Subgroup analyses revealed significantly greater sensitivity for the deep learning (DL) models than for the radiomics (0.91 vs. 0.75; p < 0.01) and automatic models compared with manual segmentation (0.86 vs. 0.76; p = 0.03). Notably, single‐center independent validation (0.92) outperformed both multicenter external (0.79) and internal validation (0.72) strategies (p < 0.01). No significant performance differences were observed across imaging modalities, phase protocols, clinical variable integration, geographic regions, or sample sizes. Conclusion This study confirms the significant potential of radiomics and DL models for the preoperative prediction of the pathological grade of ccRCC. Nevertheless, future multicenter validation is essential to address the performance gap observed in external datasets. Trial Registration Prospero: CRD42023455847

ABSTRACTBackgroundTo correlate the utility of Fundamentals of Laparoscopic Surgery (FLS) manual skills program with the Objective Structured Assessment of Technical Skills (OSATS) global rating scale in evaluating operative performance.Materials and MethodsThe Asian Urological Surgery Training and Educational Group (AUSTEG) Laparoscopic Upper Tract Surgery Course (LUTSC) implemented and validated the FLS program for its usage in laparoscopic surgical training. Delegates’ basic laparoscopic skills were assessed using three different training models (Peg Transfer, Precision Cutting and Intra-corporeal Suturing). They also performed live porcine laparoscopic surgery at the same workshop. Live surgery skills were assessed by blinded faculty using the OSATS rating scale.ResultsFrom 2016 to 2019, a total of 81 certified urologists participated in the course, with a median of 5 years’ experience post residency. Although differences in task timings did not reach statistical significance, those with more surgical experience were visibly faster at completing the peg transfer and intra-corporeal suturing FLS tasks. However, they took longer to complete the precision cutting task than participants with less experience. Overall OSATS scores correlated weakly with all three FLS tasks (Peg Transfer Time: R = -0.331, R2 = 0.110; Precision Cutting Time: R = - 0.240, R2 = 0.058; Suturing with Intra-corporeal Knot Time: R = -0.451, R2 = 0.203).ConclusionFLS task parameters did not correlate strongly with OSATS globing rating scale performance. Although the FLS task models demonstrated strong validity, it is important to assimilate the inconsistencies when benchmarking technical proficiency against real-life operative competence, as evaluated by FLS and OSATS respectively.

Purpose: Irreversible electroporation (IRE) is a promising alternative treatment for low-intermediate-risk localized prostate cancer. In this systematic review we aim to evaluate the safety profile and functional and oncological outcomes of this new technique. Materials and Methods: A systematic review of the literature was performed on PubMed, EMBASE, and Scopus up to 24 August 2023. Nineteen studies were analyzed, including 12 prospective studies and 7 retrospective studies. A total of 1,452 patients underwent IRE as the sole primary treatment modality. Results: The in-field clinically significant prostate cancer rate was reported between 0%-15.6% in the repeat biopsy. The retreatment rate was reported from 8% to 36.6%. The 3 years failure-free survival was presented between 90%-96.8%. The post-operative pad-free rate ranged between 96.7%-100%. Greater heterogeneity exists considering the change in erectile function. The most common reported complications were urinary tract infection and hematuria. Major complications were rare. Conclusions: These results underline that IRE achieves favorable oncological control with an excellent safety profile, in the meantime preserving patients' urinary and erectile function

Prostate cancer is one of the most common malignancies in men,and radical prostatectomy(RP)is the primary treatment method for localized and locally advanced prostate cancer.However,due to surgical trauma,patients undergoing RP often face postoperative complications such as sexual dysfunction and urinary incontinence,leading to varying degrees of decline in quality of life.Currently,there is a lack of standardized clinical guidelines for postoperative rehabilitation in these patients.To address this issue,the present consensus was developed using evidence-based medicine approaches,including a thorough review and evaluation of relevant literature,quality grading,and evidence synthesis.An initial draft was created and subsequently refined through expert meetings,discussions and Delphi surveys.This process involved three rounds of consultations with 29 experts from 24 different hospitals across various specialties,including urology,oncology,rehabilitation medicine,nutrition and psychology.The results were systematically summarized under the guidance of the Committee of Integrated Rehabilitation for Urogenital Tumors,Chinese Anti-Cancer Association,culminating in the formulation of the"Chinese expert consensus on perioperative integrated rehabilitation for radical prostatectomy(2024 edition)".This consensus aimed to provide standardized integrated rehabilitation recommendations for patients undergoing RP,with the goals of improving postoperative recovery efficiency and reducing the impact of both short-and long-term complications on survival and quality of life.The consensus has been registered on Practice guideline REgistration for transPAREncy(PREPARE)with the registration number PREPARE-2024CN666.The consensus covers several key areas,including comprehensive perioperative assessment,application of the Enhanced Recovery After Surgery(ERAS)principles,management and treatment of common postoperative complications,and psychological and social support for patients.Regarding perioperative assessment,the consensus emphasizes a thorough evaluation of patients'physical and psychological conditions before surgery,including nutritional status,pelvic floor function and psychological state,to develop individualized rehabilitation plans and optimize preoperative preparation,thereby laying a solid foundation for postoperative recovery.The application of ERAS principles includes reducing preoperative fasting and fluid restrictions,improving perioperative management,providing preoperative education,and implementing psychological interventions,all of which effectively reduce the incidence of postoperative complications and accelerate recovery.For common postoperative complications such as urinary incontinence and sexual dysfunction,the consensus recommends various rehabilitation measures,including pelvic floor muscle training(PFMT)and biofeedback therapy,to alleviate symptoms and improve quality of life.Additionally,the consensus underscores the importance of psychological and social support,advising comprehensive support for patients in the postoperative period.The publication of this consensus provides clinical practitioners with standardized guidelines for postoperative rehabilitation,which can enhance the recovery efficiency of patients undergoing RP,reduce the incidence of complications,and significantly improve the quality of life.As more clinical studies are conducted in the future,the content of this consensus will be continuously validated and refined,offering more comprehensive and personalized rehabilitation guidance for prostate cancer patients.

You have accessJournal of UrologyCME1 Apr 2023MP55-06 IS SYSTEMATIC BIOPSY STILL NEEDED IN MRI GUIDED PROSTATE BIOPSY? A MULTI-CENTRE ASIAN COHORT Peter Ka-Fung Chiu, Alex Mok, Jeffrey J Leow, Kai Zhang, Chih Hung Chiang, Po Fan Hsieh, Wayne Lam, Woon Chau Tsang, Hoi Chak Chan, Yu Hua Fan, Tzu Ping Lin, Tetsu Hayashi, Kazumi Kamoi, Hiromi Uno, Jason Letran, Yao Zhu, Hai Feng Wan, Tsz Yeung Chan, Chao Yuan Huang, Gang Zhu, Hsi-Chin Wu, Edmund Chiong, Chi Fai Ng, and Sunao Shoji Peter Ka-Fung ChiuPeter Ka-Fung Chiu More articles by this author , Alex MokAlex Mok More articles by this author , Jeffrey J LeowJeffrey J Leow More articles by this author , Kai ZhangKai Zhang More articles by this author , Chih Hung ChiangChih Hung Chiang More articles by this author , Po Fan HsiehPo Fan Hsieh More articles by this author , Wayne LamWayne Lam More articles by this author , Woon Chau TsangWoon Chau Tsang More articles by this author , Hoi Chak ChanHoi Chak Chan More articles by this author , Yu Hua FanYu Hua Fan More articles by this author , Tzu Ping LinTzu Ping Lin More articles by this author , Tetsu HayashiTetsu Hayashi More articles by this author , Kazumi KamoiKazumi Kamoi More articles by this author , Hiromi UnoHiromi Uno More articles by this author , Jason LetranJason Letran More articles by this author , Yao ZhuYao Zhu More articles by this author , Hai Feng WanHai Feng Wan More articles by this author , Tsz Yeung ChanTsz Yeung Chan More articles by this author , Chao Yuan HuangChao Yuan Huang More articles by this author , Gang ZhuGang Zhu More articles by this author , Hsi-Chin WuHsi-Chin Wu More articles by this author , Edmund ChiongEdmund Chiong More articles by this author , Chi Fai NgChi Fai Ng More articles by this author , and Sunao ShojiSunao Shoji More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003308.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To evaluate the additional role of systematic biopsy in predicting clinically significant prostate cancer(csPCa) among Asian men with MRI-guided prostate biopsies performed. METHODS: The analyses were done in 5240 Asian men in a multicenter MRI-guided biopsy database of 21 Asian centers in Hong Kong, Shanghai, Beijing, Taiwan, Singapore, Japan, and the Philippines. Each men underwent MRI-targeted and systematic biopsy. The role of systematic biopsy in various PI-RADS and PSA levels in predicting clinically significant prostate cancer(ISUP>=2) was evaluated. RESULTS: 3080 men with prostate volume and PI-RADS score available, and systematic and targeted biopsies reported separately, were included. 4.9%, 42.6%, 35.8% and 14.7% patients had highest PI-RADS score 2, 3, 4 and 5, respectively. The median PSA, PSA density, targeted cores, and systematic cores were 8.2, 0.19, 3 and 12 respectively. 54.9% had PCa and 41.1% had csPCa. csPCa was diagnosed in 9.7%, 22.5%, 57.2% and 78.1% of men with PI-RADS score 2,3,4 and 5, respectively. csPCa diagnosed only on systematic biopsy but not on targeted biopsy is shown in Table 1. CONCLUSIONS: csPCa on additional systematic biopsy was only 5.6% in men with PSA density<0.15. Additional systematic biopsy has limited role in men with highest PI-RADS score of 2 or 3, and PI-RADS 4 with PSA density<0.15. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e765 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Peter Ka-Fung Chiu More articles by this author Alex Mok More articles by this author Jeffrey J Leow More articles by this author Kai Zhang More articles by this author Chih Hung Chiang More articles by this author Po Fan Hsieh More articles by this author Wayne Lam More articles by this author Woon Chau Tsang More articles by this author Hoi Chak Chan More articles by this author Yu Hua Fan More articles by this author Tzu Ping Lin More articles by this author Tetsu Hayashi More articles by this author Kazumi Kamoi More articles by this author Hiromi Uno More articles by this author Jason Letran More articles by this author Yao Zhu More articles by this author Hai Feng Wan More articles by this author Tsz Yeung Chan More articles by this author Chao Yuan Huang More articles by this author Gang Zhu More articles by this author Hsi-Chin Wu More articles by this author Edmund Chiong More articles by this author Chi Fai Ng More articles by this author Sunao Shoji More articles by this author Expand All Advertisement PDF downloadLoading ...

Background: Radical prostatectomy (RP) and radical cystectomy (RC) with concurrent pelvic lymph node dissection (PLND) are considered as the curative surgical treatment options for localized prostate cancer (PC) or muscle-invasive bladder cancer (BC). Regarding lymphatic leakage management after PLND, there is no standard of care, with different therapeutic approaches having been reported with varying success rates. Methods: Seventy patients underwent pelvic lymphadenectomy during robotic RP and RC with postoperative pelvic drainage volume more than 50 mL/day before the removal of drainage tube, were retrospectively evaluated in this study between August 2015 and June 2023. If the pelvic drainage volume on postoperative Day 2 was more than 50 mL/day, a drainage fluid creatinine was routinely tested to rule out urine leakage. We removed the drainage if the patient had no significant abdominal free fluid collection, no abdominal distension or pain, no fever, and no abdominal tenderness. After 1-day observation of the vital signs and abdominal symptoms, the patient was discharged and followed-up in clinic for 2 weeks after surgery. Results: Forty-one cases underwent the early drainage removal even if the pelvic drainage volume was more than 50mL/day. Among these forty-one cases, twenty-five drainage tubes were removed when drainage volume was more than 100 mL/day. All the forty-one cases with pelvic drainage volume greater than 50mL/day were successfully managed with the early drainage removal. No paracentesis or drainage placement was required. No readmission occured during the follow-up period. Conclusion: It is safe to manage the high-volume pelvic lymphatic leakage by early clamping of the drainage tube, ultrasonography assessment of no significant residual fluid in the abdominal and pelvic cavity, and then the early removal of the drainage tube.

目的 研究P53和Ki-67蛋白在前列腺癌组织中的表达情况,探讨P53和Ki-67蛋白的表达与前列腺癌临床病理特征之间的关系.方法 应用免疫组化法检测90例根治性前列腺癌切除术后组织标本中P53、细胞增殖指标Ki-67的表达情况.记录所有患者年龄、术前血清前列腺特异性抗原(PSA)水平、术后Gleason评分、病理分期、神经血管癌栓浸润情况.分析P53表达与上述各项指标的相关性.结果 前列腺癌组织P53和Ki-67表达(≥3％)阳性率分别为27.8％(25/90)和46.7％(42/90).P53在pT2和pT3～T4期的阳性率为50.0％和19.7％(P=0.005),而Ki-67在pT2和pT3～T4期的阳性率为36.4％和75.0％(P=0.001).Ki-67在Gleason评分≤6分、7分和≥8分组中表达阳性分别为30.4％、53.8％和66.7％,差异具有统计学意义.P53表达阳性与Ki-67表达相关(P=0.012).P53表达与年龄、术前血PSA水平、术后Gleason评分、血管神经癌栓浸润差异无统计学意义.结论 前列腺癌P53蛋白表达与肿瘤分期和Ki-67相关,而Ki-67表达与肿瘤分期分级均相关.

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.

To evaluate the clinical value of the holographic imaging technology in combination with robotic-assisted partial nephrectomy (RAPN) for renal hilar tumor treatment. From Dec. 2018 to Dec. 2021, patients diagnosed with renal hilar tumor were included in this retrospective study. Before the surgery, the engineers established the holographic image models based on the enhanced CT data. The models were used in patient consultation, pre-surgery planning and surgery simulation. During the RAPN, the navigation was achieved by real-time overlapping of the holographic images on the robotic surgery endoscopic views. The navigation technique helped the surgeon to identify the important anatomic structures such as tumor, renal vein, renal artery, and pelvis. There were total of eight patients with renal hilar tumor who underwent RAPN combined with holographic imaging technique. The mean age was 57.3 years, the median ASA score was 2. The mean tumor size was 42.4 mm and the median RENAL Nephrometry score was 9.5. The clinical stages were cT1a (37.5%) and cT1b (62.5%). All the procedures were performed uneventfully by one surgeon. The mean operative time was 144.3 min, and the mean warm ischemia time was 27.9 min. The mean estimated blood loss was 86.3 ml. There was no conversion to open surgery or radical nephrectomy. There were no Clavien–Dindo ≥ 3 perioperative complications. Using the holographic imaging technique, the pre-surgery planning, simulation of renal arterial clamp and excision of the tumor, and intraoperative navigation were feasible and helpful in facilitating RAPN.

INTRODUCTION:The aim of this study was to compare the efficacy of mirabegron plus tamsulosin to tamsulosin monotherapy in terms of ureteral stent-related discomfort after ureteroscopic lithotripsy.METHODS:A total of 102 patients undergoing ureteroscopic lithotripsy and silicone ureteral stent placement were enrolled in this study. Patients were randomized 1:1 to receive either tamsulosin 0.4 mg once daily or mirabegron 50 mg + tamsulosin 0.4 mg once daily during the stenting period. Before the operation, the IPSS, QOL, and pain score were collected. On the day of ureteral stent removal, the USSQ, analgesic usage amount was collected and recorded.RESULTS:The median USSQ-body pain score in the tamsulosin group and tamsulosin + mirabegron group was 15 and 16, respectively (p = 0.530). The median analgesic usage in the two groups was 3 and 2, respectively (p = 0.170). The median USSQ-urinary symptoms, USSQ-general health, USSQ-work performance, USSQ-sexual matters, and USSQ-additional problems in the two groups were 26 and 26 (p = 0.194), 11 and 12 (p = 0.068), 12 and 13 (p = 0.105), 2 and 2 (p = 0.437), 9 and 9 (p = 0.533), respectively. The international patients used more analgesics than Chinese patients (6 vs. 1, p = 0.015).CONCLUSION:Compared to tamsulosin alone, tamsulosin + mirabegron showed no additional benefit on the ureteral stent-related pain control after ureteroscopic lithotripsy and silicone stent placement. There was no significant difference on the analgesic usage and USSQ scores between the two groups. Chinese patients request fewer analgesics than international patients.

欧洲泌尿外科学会（European Association of Urology,EAU）肾细胞癌（renalcellcarcinaoma,RCC）指南是比较成熟的指南之一。2020版EAURCC指南更新过程中指南委员会对RCC相关文献进行检索,识别出2 225篇相关新文献,最终增加了49篇参考文献。本文对更新的内容进行陈述并进行相应点评。

Objective:To evaluate the efficacy of Mirabegron and Tamsulosin versus Tamsulosin in patients with ureteral stents after ureteroscopic lithotripsy.Methods:A total of 90 patients from Beijing United Family Hospital underwent ureteroscopic lithotripsy and ureteral stenting from October 2020-August 2021 were included in this study, According to the random number table, 45 patients were randomized to receive Tamsulosin 0.2 mg every day, another 45 patients received Tamsulosin 0.2 mg and Mirabegron 50 mg every day. The patients′ characteristics, USSQ scores, and analgesic usage were recorded and analyzed. The Mann-Whitney U test was performed to compare variables of skewed distribution between the two groups. Results:For the Tamsulosin group and combination group, the median age was 41 years and 44 years, the median pain score pre-operation was 8 in both groups, the median IPSS score was 5 and 3, the median QOL score was 2 in both groups, the median stone diameter was 7 mm in both groups, the median operation time was 35 min in both groups, the median length of hospital stay was 17 h and 19 h, the median stent placement time was 10 d and 12 d. The median USSQ urinary symptoms score was 26 and 28, the median USSQ body pain score was 15 and 16, the median USSQ general health score was 11 and 12, the median USSQ working performance score was 12 and 14, the median USSQ sexual matters score was 2 in both groups, the median USSQ additional problems score was 9 and 10. The median analgesic ibuprofen usage was 3 tablets and 2 tablets. For Chinese patients and foreign patients, the median USSQ body pain score was 15.5 and 16.0, the median analgesic usage was 1.5 tablets and 6.0 tablets ( P<0.05). Conclusion:Mirabegron does not add additional effects on the post ureterisocpic lithotripsy and ureteral stent placement related symptom and pain control. Foreign patients requested significantly more analgesics than Chinese patients.

Objective:To evaluate the clinical value of the holographic image and navigation in robotic assisted laparoscopic radical prostatectomy (RARP) .Methods:From Sept. 2020 to Dec. 2020, 5 patients diagnosed with prostate cancer in Beijing United Family Hospital were included in this study. The mean age was 57 years(38-69 years). Before the operation, the engineers established the holographic image based on the enhanced MRI images. The holographic images were used in pre-surgery planning. During the operation, the navigation was achieved by real time fusing holographic images with the robotic surgery endoscopic views. Some important structure such as prostate, bladder neck and the tumor could be observed and monitored in real time. The No.1 patient had high-risk prostate cancer, underwent RARP+ extended pelvic lymph node dissection; The No.2 patient had low-risk prostate cancer, underwent RARP, and the right side neurovascular bundle (NVB) was preserved; The No.3 patient had low-risk prostate cancer, underwent RARP, and the bilateral side NVB was preserved; The No.4 patient had low-risk prostate cancer, underwent RARP, and the right side NVB was preserved; The No.5 patient had high-risk prostate cancer, underwent RARP+ extended pelvic lymph node dissection, and the bilateral side NVB was preserved.Results:All the 5 cases surgeries were successful, no conversion to open surgery, the mean operation time was 161.7min (160-250min), the mean blood loss was 426.7 ml(60-1000 ml). The pathological results were pT 3bN 0 cM 0, pT 2aN 0 cM 0, pT 2aN 0 cM 0, pT 2aN 0 cM 0 and pT 3aN 1 cM 0, respectively. There was no over Clavien Dindo Ⅱ perioperative complications. 4 patient achieved continence when catheter removal. The PSA level and erectile function were monitored in the follow up. Conclusions:Holographic image navigation might have clinical value in RARP.

随着临床分期的不断细化以及多学科诊疗的不断进展,睾丸肿瘤的治愈率可以超过95％.腹膜后淋巴结清扫术(RPLND)是睾丸非精元细胞瘤多模式治疗重要的一部分,对总体治愈率做出了重要贡献.双侧保留神经的RPLND对于肿瘤学控制及功能恢复是适当的选择,腹腔镜和机器人辅助的RPLND都是安全有效的选择.

The highlight of the 2020 EAU guideline updates on the systemic therapy for advanced and metastatic renal cell carcinoma is that monotherapy tyrosine kinase inhibitors, e.g. sunitinib, pazopanib, cabozantinib are not recommended as fist line treatment option for clear-cell metastatic renal cell carcinoma. Instead, immune checkpoint inhibitor combination therapy becomes the first choice for these patients. However, the targeted therapies can be offered as second-line therapy to patients refractory to pembrolizumab plus axitinib or nivolumab plus ipilimumab.

Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery.Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan.2019 to Dec.2019 in Beijing United Family Hospital and other 18 medical centers,including 78 cases of renal tumor,2 cases of bladder cancer,2 cases of adrenal gland tumor,1 cases of renal cyst,1 case of prostate cancer,1 case of sweat gland carcinoma with lymph node metastasis,1 case of pelvic metastasis after radical cystectomy.All the patients underwent operations.In the laparoscopic surgery group,there were 27 cases of partial nephrectomy,1 case of radical prostatectomy,2 cases of radical cystectomy and 2 cases of adrenalectomy.In the da Vinci robotic surgery group of 54 cases,there were 51 cases of partial nephrectomy,1 case of retroperitoneal lymph node dissection,1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis.There were 41 partial nephrectomy patients with available clinical data for statistic,with a median age of 53.5 years (range 24-76),including 26 males and 15 females.The median R.E.N.A.L score was 7.8 (range 4-11).Before the operation,the engineers established the holographic image based on the contrast CT images and reports.The surgeon applied the holographic image for preoperative planning.During the operation,the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen.Results All the procedures had been complete uneventfully.The holographic images helped surgeon in understanding the visual three-dimension structure and relation of vessels supplying tumor or resection tissue,lymph nodes and nerves.By manipulating the holographic images extracorporeally,the fused image guide surgeons about location vessel,lymph node and other important structure and then facilitate the delicate dissection.For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy,the median operation time was 140 (range 50-225) min,the median warm ischemia time was 23 (range 14-60) min,the median blood loss was 80(range 5-1 200) ml.In the robotic surgery group,the median operation time was 140 (range 50-215)min,the median warm i schemia time was 21 (range 17-40)min,the median blood loss was 150(range 30-1 200)ml.In the laparoscopic surgery group,the median operation time was 160(range 80-225)min,the median warm ischemia time was 25 (range 14-60)min,the median blood loss was 50 (range 5-1 200) ml.All the patients had no adjacent organ injury during operation.There were 2 cases with Clavien Ⅱ complications.One required transfusion and the other one suffered hematoma post-operation.However,the tumors were located in the renal hilus for these 2 cases and the R.E.N.A.L scores were both 11.Conclusions Holographic image navigation can help location and recognize important anatomic structures during the surgical procedures..This technique will reduce the tissue injury,decrease the complications and improve the success rate of surgery.

The incidence of prostate cancer in China has been increasing rapidly in recent years. Randomized studies in Europe have showed that PSA-based screening can reduce mortality, but it may lead to overdiagnosis and subsequent overtreatment. Large-scale randomized controlled prostate cancer screening has not yet been conducted in China. Emerging techniques and strategies may improve prostate cancer screening; however, they will surely meet challenges which require newsolutions.

The robot-assisted laparoscopic management of post-chemotherapy retroperitoneal metastasis and inferior vena cava tumor thrombus secondary to testicular cancer is a challenging task for urologists. A pathological examination of a 36-year-old Caucasian man who had undergone a right radical orchiectomy showed mixed testicular germ cell cancer (70% embryonal cancer and 30% seminoma); he had undergone four prior courses of cisplatin, etoposide, and bleomycin chemotherapy and was found to have residual retroperitoneal enlarged lymph nodes close to the right renal hilum and a 9.8 cm inferior vena cava tumor thrombus (pT1, N2, M1, S2). Pre-surgical three-dimensional image reconstruction was performed based on contrast computed tomography data. The inferior vena cava tumor thrombus was found in the vena cava at the level of the celiac trunk and the inferior mesenteric artery. Our patient accepted treatment with robot-assisted laparoscopic retroperitoneal lymph node dissection with concomitant inferior vena cava thrombectomy and cava reconstruction on September 12, 2018. During the procedure, a drop-in robotic ultrasound probe was used to define the thrombus. Vena cavoscopy using a flexible ureteroscope found that the tumor thrombus adhered to the cava wall in all directions. The tumor thrombus was dissected free from the inferior vena cava lumen, and vena cava reconstruction was achieved using the da Vinci™ Si HD surgical system. The operative time was 550 minutes. The intraoperative estimated blood loss was 2300 ml. Intraoperative blood transfusions consisted of 10 units of red blood cells (Clavien-Dindo grade II). No Clavien-Dindo grade III or above perioperative complications occurred. The length of hospital stay was 7 days. Pathology revealed no viable cancer cells in any of the residual lymph node tissues or in the vena cava tumor thrombus. This is the first case of robot-assisted laparoscopic retroperitoneal lymph node dissection with concomitant inferior vena cava thrombectomy and reconstruction for metastatic mixed testicular germ cell cancer published to date. This complicated surgical procedure was facilitated by the innovative usage of three-dimensional image reconstruction for defining the vena cava tumor thrombus, a robotic ultrasound probe for intraoperatively defining the vena cava tumor thrombus, and vena cavoscopy using a flexible ureteroscope.

Objective To compare the diagnosis accuracy of clinically significant prostate cancer by two different MRI-targeted biopsy approaches. Methods A total of 45 men from Beijing United Family Hospital undergoing cognitive biopsy and 87 men from Beijing Hospital undergoing in-bore biopsy were included in the study from 2015 to 2017. The patients age, PSA, prostate volume, PI-RADS, overall prostate detection rate and clinically significant prostate cancer detection rate were compared and analyzed. Results The age in in-bore biopsy group was higher than cognitive biopsy group. There was no significant difference in PSA, prostate volume, and distribution of PI-RADS between the two groups. The overall prostate cancer detection rate was 52.9% by in-bore biopsy and 31.1% by cognitive biopsy (P 0.05), respectively. Conclusions Both biopsies had good performance in clinically significant prostate cancer detection. But in-bore biopsy showed remarkably higher overall prostate cancer detection rate compared with cognitive biopsy. Key words: MRI-targeted biopsy; Prostate carcinoma; Prostate biopsy; Diagnosis