Importance: Successful needle puncture of the renal collecting system is a critical but difficult procedure in percutaneous nephrolithotomy (PCNL). Although fluoroscopy and ultrasound are the standard imaging techniques to guide puncture during PCNL, both have known limitations. Objective: To assess the feasibility and safety of a new navigation system for needle puncture in ultrasound-guided PCNL. Design: This study employed a single-center randomized controlled trial (RCT) design to assess the feasibility and safety of a new navigation system for needle puncture in ultrasound-guided PCNL. Conducted between May 2021 and November 2021, the trial utilized computer-generated random numbers for participant allocation to control for selection bias. Setting: The trial was executed at Department of Urology, Peking University First Hospital in Beijing, China, which serves as an academic medical center. Participants: All patients who met the inclusion criteria were randomly divided into two groups, with 29 patients in each group. One group underwent PCNL procedures using the new navigation system, while the control group underwent standard ultrasound-guided PCNL procedures. Included patients had renal pelvis or caliceal calculi larger than 2.0 cm in diameter or had multiple or staghorn stones. The puncture procedure was performed with the support of real-time ultrasound imaging and visual guidance displayed on the screen. Main Outcomes and measures: The primary outcome was system feasibility and puncture success rate. Secondary outcomes included puncture time, total surgical time, number of attempts, postprocedure complications, and 1-year and 3-year stone recurrence rates. Stone clearance was defined by postoperative CT. Descriptive statistics summarized patient demographics, stone size, and location. Independent samples t-tests analyzed puncture time and total surgical time. chi(2) or Fisher's exact tests compared stone clearance, complications, socioeconomic status, renal hydronephrosis, stone location, race, and medical history. Linear regression examined the correlation between BMI and puncture time. Significance was set at P<0.05. Results: For all 58 patients undergoing PCNL, needle punctures of the renal collecting system were completed with a success rate of 100%. The average time from planning the puncture protocol to successful puncture was significantly shorter in the AcuSee guidance system group (3.12 min, range 0.2-6.88 min) compared to the standard ultrasound-guided group (7.58 min, range 5.41-10.68 min), representing a reduction of similar to 59%. The total surgical time was also shorter in the AcuSee group for patients with no and mild hydronephrosis (P<0.05). Complication rates were lower in the AcuSee group, with no major complications observed. However, three patients in the standard ultrasound-guided group have adverse effects after the PCNL procedure. The 1-year stone recurrence rate was significantly lower in the AcuSee group (3.4%) compared to the standard group (24.1%), and the 3-year recurrence rate was also lower (6.9% vs. 41.4%). Patient-specific factors such as BMI, renal morphology, and prior surgical history did not significantly affect the performance of the AcuSee system. Conclusions and relevance: The authors report the first clinical application of a new navigation system for needle puncture in ultrasound-guided PCNL. It has been demonstrated that it is feasible and safe compared to the standard ultrasound-guided group in percutaneous renal puncture. This technology provides intuitive and easy-to-use visual guidance, which may facilitate safe, accurate, and fast needle puncture of the kidney.

ObjectivesTo assess the feasibility, safety, and short-term outcomes of ultrasound-guided percutaneous nephrolithotomy (PCNL) performed by a single early-career urologist without fluoroscopic guidance.MethodsWe retrospectively analyzed 70 consecutive ultrasound-guided PCNL cases performed independently by a single early-career urologist at Peking University First Hospital. All procedures employed single-tract, rigid ureteroscopy-assisted access under real-time ultrasound guidance without fluoroscopy. Perioperative parameters included access success, operative time, hemoglobin drop, stone-free rate, and complications. An accompanying educational video was included to facilitate reproducibility.ResultsThe stone-free rate after a single procedure was 75.7%, rising to 88.6% at 6-month follow-up. No major complications occurred. The mean stone size was 2.22 cm. Mean access time was 9 min. Access was successfully achieved in all cases. These outcomes were achieved despite the surgeon's early learning curve, reflecting a high degree of technical feasibility and safety under structured mentorship.ConclusionsUltrasound-guided PCNL is a safe, effective, and radiation-free alternative to fluoroscopy-guided procedures. It can be reliably adopted early in surgical practice. The accompanying video supports broader understanding and dissemination of this radiation-free approach, especially in resource-limited or high-volume centers.

This study aimed to investigate the influence of surgical intervention on recurrence risk of upper urinary tract stone and compare the medical burden of various surgical procedures. This study analyzed data from patients with upper urinary tract stone extracted from a national database of hospitalized patients in China, from January 2013 to December 2018. Surgical recurrence was defined as patients experience surgical procedures for upper urinary tract stone again with a time interval over 90 days. Associations of surgical procedures with surgical recurrence were evaluated by Cox regression. In total, 556,217 patients with upper urinary tract stone were included in the present analysis. The mean age of the population was 49.9 ± 13.1 years and 64.1

目的:探讨上尿路尿路上皮癌(UTUC)患者术后尿路外复发影响因素及危险分层价值.方法:回顾性分析2010年1月-2014年12月收治135例行根治手术治疗UTUC患者临床资料,采用单因素和多因素法分析术后尿路外复发影响因素,同时根据危险度分层比较随访无局部复发生存率和无远处转移生存率.结果:①无蒂状肿瘤、多病灶、输尿管癌、淋巴脉管侵犯、病理分期≥T3期、eGFR<60 mL·min-1·1.73 m-2)及Fib≥3.2 g/L患者无局部复发生存率均显著低于其他患者(P<0.05);肿瘤分级G3级、无蒂状肿瘤、淋巴脉管侵犯、中重度肾盂积水及中性粒-淋巴细胞比值>2.0患者无远处转移生存率均显著低于其他患者(P<0.05);②多因素分析结果提示,输尿管癌、淋巴脉管侵犯、病理分期≥T3期及Fib≥3.2 g/L均是患者无局部复发生存率独立危险因素(P<0.05);无蒂状肿瘤、淋巴脉管侵犯及中性粒-淋巴细胞比值>2.0均是患者无远处转移生存率独立危险因素(P<0.05);③低危组随访1、3、5年无局部复发生存率显著高于中危组和高危组(P<0.05);低危组随访1、3、5年无远处转移生存率显著高于中危组和高危组(P<0.05).结论:输尿管癌、淋巴脉管侵犯、病理分期≥T3期及Fib≥3.2 g/L与UTUC患者术后局部复发密切相关;而无蒂状肿瘤、淋巴脉管侵犯及中性粒-淋巴细胞比值>2.0则可增加术后远处转移风险;根据相关独立危险因素进行危险度分层能够有效预测患者临床预后.

目的:研究经皮肾镜取石术(PCNL)后发生发热及全身炎症反应综合征(SIRS)的原因及诊治经验,并指导临床早期发现,及时干预,提高围手术期安全.方法:回顾性分析北京大学第一医院泌尿外科2015年11月～2016年10月行PCNL的187例患者的临床资料,采用x2检验和多因素Logistic回归分析的统计学方法,研究术后出现发热和SIRS与患者的年龄、性别、是否合并糖尿病、是否为鹿角形结石、是否患肾积水、术前是否合并尿路感染、术前麻醉ASA分级、手术时间、术后有无残石的关系.结果:187例患者,术后发热25例(13.4％),术后SIRS 19例(10.2％).研究发现,女性和术前无肾积水与术后发热相关(P＜0.05);术前尿路感染、术前无肾积水与术后SIRS相关(P＜0.05);多因素Logistic回归分析提示,女性和术前无肾积水是术后发热的危险因素(P＜0.05),术前无肾积水是术后SIRS的危险因素(P＜0.05).结论:发热和SIRS都是PCNL术后常见的并发症,术前无肾积水的患者术后发生发热和SIRS的风险增加,而女性患者更易在术后出现发热反应.

目的探讨DDD肾肿瘤评分系统对于肾肿瘤手术的指导意义。方法选择北京大学第一医院泌尿外科2013年1月至2017年9月收治2977例病理诊断为肾细胞癌的患者进行病例回顾,筛选病例资料包含泌尿系增强CT的患者561例,收集患者的年龄、性别、手术方式等数据,对其术前CT或磁共振进行回顾分析并进行RENAL及DDD（D1为位于肾内的肿瘤的最长径;D2为肿瘤边界距离肾髓质或肾窦和集合系统的最短距离;D3肿瘤距离肾动静脉主干的距离）系统评分。将各径线D1、D2、D3评分与手术方式进行Mann-Whitney秩和检验,进一步使用Mann-Whitney秩和检验方法,比较不同DDD系统评分与RENAL评分对手术方式的决策影响。结果 RENAL及DDD系统评分均可分为3组:低度、中度、高度。对于肾部分切除（PN）与肾根治性切除（RN）的比较分析,RENAL及DDD系统评分差异具有统计学意义（P ＜0.001）,评分越低,行肾部分切除术的比率越高。对于腹腔镜肾部分切除术（LPN）与腹腔镜肾根治性切除术（LRN）,RENAL及DDD系统评分差异具有统计学意义（P ＜0.001）,评分越低,行腹腔镜部分肾切除的比率越高。对于LRN及开放肾根治切除术（ORN）的比较分析显示,低分组及中分组在使用RENAL及DDD系统评分差异均无统计学意义（P值分别为0.135和0.602）,但是低分组与高分组比较时两评分系统差异均具有统计学意义（P值分别为0.025和＜0.018）,评分越高,行开放肾根治性切除术的比率越高。结论 DDD肾肿瘤评分系统评分是一种直观简便的描述肾肿瘤解剖特征的综合评估体系,具有良好的稳定性,可以反映肾肿瘤手术的难度,协助临床医师进行肾肿瘤的手术决策。

Objective To summarize the characteristics of clinical manifestation of bone flare after the treatment with new endocrine therapy in patients with metastatic castration-resistant prostate cancer (mCRPC) in order to evaluate the curative effect of patients properly and determine the reasonable treatment strategy.Methods We retrospectively analyzed the clinical data of two patients with mCRPC performed "bone flare" defined as PSA decline and bone metastases progression in the initial treatment with new endocrine therapy in Urology Department of Peking University First Hospital,and analyzed the clinical characteristics and treatment methods with the relative literature.Case 1,a 79-year-old man,presented with frequent urination and prostate-specific antigen (PSA) was 115.900 ng/ml,was diagnosed as prostate cancer (cT3N0M1) with bone metastasis.After androgen deprivation therapy of 24 months,PSA elevated and multiple bone metastases progressed.The patient was diagnosed with mCRPC and then began the treatment of enzalutamide.Case 2,a 62-year-old man,complained about emaciation and frequent urination,was diagnosed with prostate cancer(cT4N1M1)with bone and lymph metastases.After androgen deprivation therapy of 22 months,PSA elevated and multiple bone metastases progressed.The patient was diagnosed with mCRPC and then began the treatment of abiraterone.Results Case 1 was treated with enzalutamide and 2 months later PSA decreased from 133.400 ng/ml to 5.530 ng/ml,while bone scan showed multiple bone metastases,part of which was newly metastatic lesions.6 months later,the number of metastatic lesions kept stable,and part of lesions presented metabolism decrease.8 months later,the number of metastatic lesions began to decrease.1 year later,the patient started to receive chemical therapy because of the progression of the disease.After 5 cycles of chemotherapy,PSA progression occurred and chemotherapy was stopped.Liver failure and disseminated intravascular coagulation caused death in June 2016.Case 2 was treated with abiraterone and 2 months later PSA decreased from 54.820 ng/ml to 3.580 ng/ml,while bone scan showed multiple bone metastases,part of which was newly metastatic lesions.6 months later,the number of metastatic lesions began to decline.10 months later,the number of metastatic lesions kept stable.The treatment of abiraterone was continued so far and the patient was in a stable condition.Conclusions Enzalutamide and abiraterone,two new endocrine therapy,are determined as preferred methods for the treatment of mCRPC.The bone scanning is required to evaluate the possibility of "bone flare" which is defined as PSA decline and bone metastases progression in the initial treatment.These patients should be evaluated to make appropriate clinical decision.

BackgroundMetastasis is the primary cause of tumor death in renal cell carcinoma (RCC). Improved diagnostic markers of metastasis are critically needed for RCC. MicoRNAs are demonstrated to be stable and significant biomarkers for several malignancies. In this study, we aimed to explore the metastasis related microRNAs and its mechanism in RCC.MethodsThe relationship between microRNAs expression and prognosis and metastasis of RCC patients were explored by data mining through expression profiles from The Cancer Genome Atlas (TCGA). A total of 80 RCC tissues and adjacent normal kidney tissues were obtained from Department of Urology, Peking University First Hospital. Expression of microRNA-200b (miR-200b) in RCC tissues and cell lines were determined by bioinformatic data mining and quantitative real-time PCR (qRT-PCR). The effects of miR-200b on cell proliferation, migration and invasion were determined by cell counting kit-8 and colony formation assay, wound healing assay and Boyden chamber assay. Mouse cell-derived xenograft and patient-derived xenograft model were also performed to evaluate the effects of miR-200b on tumor growth and metastasis in vivo. The molecular mechanism of miR-200b function was investigated using bioinformatic target predication and high-throughput cDNA sequencing (RNA-seq) and validated by luciferase reporter assay, qRT-PCR, Western blot and immunostaining in vitro and in vivo.FindingsOur findings indicates that miR-200b is frequently downregulated and have potential utility as a biomarker of metastasis and prognosis in RCC. Interestingly, ectopic expression of miR-200b in the Caki-1 and OSRC-2 cell lines suppresses cell migration and invasion in vitro as well as tumor metastases in vivo. However, miR-200b has no effect on cell proliferation in vitro and tumor growth in vivo. In addition, bioinformatics target predication and RNA-seq results reveals that Laminin subunit alpha 4 (LAMA4) is one target of miR-200b and significantly inhibited by miR-200b in vitro and in vivo.InterpretationThese results demonstrate a previously undescribed role of miR-200b as a suppressor of tumor metastasis in RCC by directly destabilizing LAMA4 mRNA.

Background: Recent large high-quality trials have questioned the clinical effectiveness of medical expulsive therapy using tamsulosin for ureteral stones. Objective: To evaluate the efficacy and safety of tamsulosin for distal ureteral stones compared with placebo. Design, setting, and participants: We conducted a double-blind, placebo-controlled study of 3296 patients with distal ureteral stones, across 30 centers, to evaluate the efficacy and safety of tamsulosin. Intervention: Participants were randomly assigned (1:1) into tamsulosin (0.4 mg) or placebo groups for 4 wk. Outcome measurements and statistical analysis: The primary end point of analysis was the overall stone expulsion rate, defined as stone expulsion, confirmed by negative findings on computed tomography, over a 28-d surveillance period. Secondary end points included time to stone expulsion, use of analgesics, and incidence of adverse events. Results and limitations: Among 3450 patients randomized between September 1, 2011, and August 31, 2013, 3296 (96%) were included in the primary analysis. Tamsulosin benefits from a higher stone expulsion rate than the placebo (86% vs 79%; p < 0.001) for distal ureteral stones. Subgroup analysis identified a specific benefit of tamsulosin for the treatment of large distal ureteral stones (>5 mm). Considering the secondary end points, tamsulosin-treated patients reported a shorter time to expulsion (p < 0.001), required lower use of analgesics compared with placebo (p < 0.001), and significantly relieved renal colic (p < 0.001). No differences in the incidence of adverse events were identified between the two groups. Conclusions: Our data suggest that tamsulosin use benefits distal ureteral stones in facilitating stone passage and relieving renal colic. Subgroup analyses find that tamsulosin provides a superior expulsion rate for stones >5 mm, but no effect for stones <= 5 mm. (c) 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

OBJECTIVE:Contrast enhanced ultrasound (CEUS) is an innovative technique that employs microbubble contrast agents to demonstrate parenchymal perfusion. Ultrasound contrast agent was reported to be directly used in human internal lumen to improve the observation capacity of ultrasound. However, CEUS has never been reported to be used in the guidance of percutaneous renal access in percutaneous nephrolithotomy (PCNL). This study aimed to assess the efficacy of CEUS-guided renal access in PCNL.METHODS:In this retrospective study, percutaneous renal access was performed under real-time monitoring of CEUS during PCNL in a cohort of 20 patients with renal stones at Peking University First Hospital. Data regarding patients' demographic and clinical characteristics, therapeutic regimens, and postoperative information were collected from a comprehensive database containing comprehensive medical records of the patients undergoing PCNL. Briefly, the procedure was as follows. With the patient under general anesthesia, renal access was established by the guidance of CEUS. Afterwords, holmium laser, pneumatic or ultrasonic lithotripsy was used by the same urologist. The patient demographics, stone characteristics and procedure details were noted. Finally, appropriate statistical analyses were performed to evaluate the effectiveness and safety of the CEUS-guided percutaneous renal access in PCNL.RESULTS:All the 20 patients underwent PCNL successfully with the help of CEUS guidance for tract creation. The collecting system was successfully accessed in all the patients, and only one patient underwent re-puncture. All the patients approached through a middle-pole percutaneous access. The median puncture time was 3.9 (2.9-4.6) min, and the median operating time was 112 (98.5-134.5) min. The preliminary stone-free rate of PCNL was 95.0% (19/20) as shown by the kidney, ureter, and bladder (KUB) radiographs 48 h postoperation, and the median decline in hemoglobin level was 10 (5.5-14.5) g/L. Two patients had transient postoperative fever and responded well to antibiotics. In addition, no other major complications were observed.CONCLUSION:CEUS is a safe and effective alternative way of guidance for percuta-neous renal access for PCNL beginners. It makes this procedure more visualized and simpler, and produces clearer images than common ultrasonic ones. PCNL beginners might benefit from this method to shorten the learning curve of PCNL, while it warrants further comparative studies to clarify.

Objective To recommend our clinical experiences in five important concerns which common to be met in percutaneous nephrolithotomy (PCNL), helping the beginners easy to handle this kind of procedures.

Objective The objective of this prospective multicenter randomized controlled clinical study was to evaluate the efficacy and safety of urocalun in the management of patients with kidney ureteral calculi compared with lithagogue powder.Methods A total of 224 patients with kidney ureteral calculi less than 1 cm in diameter in seven research center from November 2013 to May 2014 were included in the study and randomly divided into 2 groups by random number table.The experiment group of 112 patients oral Quercus salicina extract capsules,2 pills every time,three times a day,and the control group of 112 patients oral lithagogue powder,1 bag every time,three times a day.All of patients were accepted 4 weeks treatment.There were no significant difference in ages,gender,duration and calculi diameter in two groups (P ＞ 0.05).Renal and ureteral calculi in two groups were 23,88 patients and 26,84 patients,separately (P ＞ 0.05).Low back pain or/and painful urination,urinary frequency,urgency symptom scores in experiment and control groups were 3.0 ± 0.7,7.6 ± 1.7,0.8 ± 0.6 and 3.0 ± 0.8,7.9 ± 1.4,0.7 ± 0.6,respectively (P ＞ 0.05).Low back pain or/and painful urination,urinary frequency,urgency symptom scores,stone discharge rate,stone down rate,stone expelling failure rate,stone discharge time,cumulative stone discharge rate per week,incidence of adverse effects and low back pain remission were evaluated after 4 weeks drug treatment.Results Low back pain or/and painful urination,urinary frequency,urgency symptom scores have significantly improved in the experiment and control groups after 4 weeks drug treatment were 1.4 ±0.6,6.3 ± 1.0,0.2 ±0.4 (P ＜0.01) and 1.7 ±0.7,6.9 ± 1.2,0.2 ± 0.4 (P ＜0.01),respectively.Relieve efficient of low back pain in experiment group was obviously higher than control group which were 64.9％ (72/111) and 36.4％ (40/110),respectively (P ＜ 0.01).Stone discharge rate,stone down rate and stone expelling failure rate in the experiment group were 56.8％ (63/ 111),12.6％(14/111),30.6％ (34/111),the control group were 39.1％ (43/110),10.0％ (11/ 110),50.9％ (56/110) (P =0.003).Overall efficient in experiment group was significantly higher than control group which were 69.4％ (77/111),49.1％ (54/110) (P =0.002).The effective rate in the patients with kidney and ureteral calculi were 52.2％ (12/23),23.1％ (6/26) and 73.9％ (65/88),57.1％ (48/84) (P ＜ 0.05),respectively.The cumulative stone discharge rate per week in experiment group were significandy higher than control groups every week after 4 weeks,which were 23.4％ (26/111),41.4％(46/111),50.5％ (56/111),56.8％ (63/111) and 10.9％ (12/110),18.2％ (20/110),28.2％ (31/110),39.1％ (43/110),respectively (P ＜0.05).There were no significant differences in incidence of adverse effects (P ＞ 0.05).Conclusions Quercus salicina extract capsules are safe and effective in the treatment of patients with the diameter of 1 cm below in kidney ureteral calculi.Compared with lithagogue powder,Quercus salicina extract capsules have higher cure rate and can obviously relieve back pain symptoms,shorten the calculi discharge time.

肾细胞癌（renal cell carcinoma ，RCC ）是泌尿系统第二大肿瘤，2013年美国新发肾或肾盂癌65150例，死亡13680例［1］。肾癌根治术（radical nephrec‐tomy ，RN）是局限性肾细胞癌的标准治疗方式。同时，随着RCC特性及其生长规律研究的不断深入，肾部分切除术（partial nephrectomy ，PN ）适用范围正在不断扩大［2‐3］。目前对于临床T1a期的RCC ，国际上推荐的临床治疗手段多为 PN［4‐5］。但对于 T1b 期RCC ，选择RN还是PN仍有争议。

目的 对比分析经腹腹腔镜与开放手术行下腔静脉后输尿管离断复位吻合术治疗下腔静脉后输尿管的疗效.方法 回顾性分析12例下腔静脉后输尿管行输尿管离断复位吻合术患者的临床资料,其中6例采用经腹腹腔镜治疗(腹腔镜组),6例采用开放手术治疗(开放组),比较两组手术时间、术中出血量、术后肠功能恢复时间、住院时间及并发症.结果 12例患者术前均明确诊断.腹腔镜组:中位手术时间100(80～120)min,中位术中出血量90(60～ 120) ml,术后第1天下床活动,2～3d肠管排气,无漏尿5d后拔除腹腔引流管,7d拔除留置尿管,中位住院时间7(4～8)d,双J管放置2～3个月;术后4、8个月均行静脉尿路造影(IVU)复查,显示肾积水明显消退2例,恢复无肾积水情况3例,证明无吻合口狭窄情况1例;术后无发热、腹腔炎性反应及肠梗阻等并发症.开放组:中位手术时间165(120～ 210) min,中位术中出血量145(90～ 200) ml,术后第2天下床轻微活动,3～4d肠管排气,无漏尿5d后拔除腹膜后引流管,7d拔除留置尿管,中位住院时间13(12～15)d,双J管放置2～3个月,术后4、8个月均行IVU复查,显示肾积水明显消退2例,恢复无肾积水情况2例,证明无吻合口狭窄情况2例;术后发热2例、切口感染2例,换药愈合,肠梗阻1例,对症处理后治愈,无腹腔炎性反应并发症.结论 经腹腹腔镜手术是治疗下腔静脉后输尿管有效的方式之一.

<正>移行细胞癌是泌尿系统肿瘤常见的病理类型,其中膀胱上皮移行细胞癌约占90%～95%,上尿路移行细胞癌(肾盂癌、输尿管癌)约占5%。双侧上尿路、膀胱全程出现移行细胞癌则较为少见,而肾结核同时合并双侧全程尿路移行细胞癌则更是罕见报道。我院于2011年收治1例,报告如下。

OBJECTIVE:To investigate the clinical significance of R.E.N.A.L. nephrometry score for renal neoplasms in patients undergoing nephron sparing surgery.METHODS:A retrospective analysis was conducted of clinical data of 110 patients with renal neoplasms undergoing nephron sparing surgery, who were admitted to Peking University First Hospital from January 2010 to January 2012. The operation approaches, perioperative variables and perioperative complications as well as R.E.N.A.L. scores were compared.RESULTS:The R.E.N.A.L. nephrometry score was significantly associated with the operation approach (P<0.001), while there was no significant association between the scoring system and the occurrence of complications (P<0.611). Meanwhile, it was associated with ischemia time (P<0.023) and percentage change in the creatinine level (P<0.025). Low complexity tumors had significantly shorter ischemia time and low percentage change in the creatinine level than high complexity tumors (P<0.008, P<0.010). Fleiss' generalized kappa was 0.52 to 0.89 for the R.E.N.A.L. nephrometry components.CONCLUSION:The R.E.N.A.L. nephrometry score is a comprehensive assessment tool for delineating renal tumor anatomy. The reproducibility of R.E.N.A.L. nephrometry scores is substantial, but further research is required to evaluate its performance in predicting operative outcomes more accurately.

PURPOSE:To explore the relationships between nephrostomy tube (NT) size and outcome of percutaneous nephrolithotomy (PCNL).METHODS:The Clinical Research Office of the Endourological Society (CROES) prospectively collected data from consecutive patients treated with PCNL over a 1-year period at 96 participating centers worldwide. This report focuses on the 3,968 patients who received a NT of known size. Preoperative, surgical procedure and outcome data were analyzed according to NT size, dividing patients into two groups, namely small-bore (SB; nephrostomy size ≤ 18 Fr) and large-bore (LB; nephrostomy size > 18 Fr) NT.RESULTS:Patients who received a LB NT had a significantly lower rate of hemoglobin reduction (3.0 vs. 4.3 g/dL; P < 0.001), overall complications (15.8 vs. 21.4%; P < 0.001) and a trend toward a lower rate of fever (9.1 vs. 10.7%). Patients receiving a LB NT conversely had a statistically, though not clinically significant, longer postoperative hospital stay (4.4 vs. 4.2 days; P = 0.027). There were no differences in urinary leakage (0.9 vs. 1.3%, P = 0.215) or stone-free rates (79.5 vs. 78.1%, P = 0.281) between the two groups.CONCLUSIONS:LB NTs seem to reduce bleeding and overall complication rate. These findings would suggest that if a NT has to be placed, it should better be a LB one.

OBJECTIVE:To study the variation of renal vessels with retroperitoneal laparoscopy so as to increase the safety of retroperitoneal laparoscopic surgeries.METHODS:A total of 525 patients underwent retroperitoneal laparoscopic nephrectomy or partial nephrectomy at our hospital between January 2004 and June 2008. There were 316 males and 209 females with a mean age of (58 ± 13) years old. The procedures were as follows: (1) patients lay on one side with their waist up and the retroperitoneal cavity was established with our institutional method; (2) gerota's fascia was separated widely along the ventral surface of major psoas muscle; (3) the tissues around renal arteries and veins were isolated by ultrasonic scalpel. Careful observation was performed to explore if there were duplicated or accessory renal vessels; (4) renal vessels were cut by Endo-GIA/Hem-o-lok or blocked by bulldog clamps; (5) whole or partial kidney was finally resected (remaining procedures omitted).RESULTS:Among all patients, 58 patients (11.0%, 58/525) had a variation of renal vessels. There were double renal arteries on one side (n = 18), double renal veins (n = 10), 3 renal veins (n = 1) and double arteries and veins on one side (n = 3). Twenty-five patients (4.8%, 25/525) had one accessory renal artery on one side while 19 (76.0%, 19/25) accessory renal arteries went toward the upper kidney pole. The diameter of one patient's left spermatic vein was similar with that of renal vein and they were joined by lumber vein.CONCLUSION:The variation of renal artery is more common than that of renal vein. The accessory renal arteries are common and usually go toward the upper kidney pole. The variation of renal vessels should be considered before and during a laparoscopic procedure.

经皮肾镜取石术(percutaneous nephrolithotomy,PNL)是治疗肾脏和上段输尿管结石的常用方法.与开放手术相比,并发症比较少,但是严重的并发症可能造成患者失去一侧肾脏,甚至死亡.因此,需要充分认识PNL可能出现的并发症,了解出现并发症时的处理方法.