The introduction of robotic surgical platforms holds the potential to accelerate the evolution of natural orifice transluminal endoscopic surgery (NOTES). This study aimed to evaluate the feasibility and safety of robotic transvaginal hybrid NOTES nephrectomy based on a retrospective case series from our hospital. From August 2019 to August 2024, a total of 23 patients underwent robotic transvaginal hybrid NOTES nephrectomy at our institution. All procedures were performed using the Da Vinci Xi robotic system. Two 8-mm robotic ports were placed at the margins of the umbilicus. Another 8-mm robotic scope port was placed transvaginally via the posterior fornix. An assistant 12-mm port was placed at the suprapubic midline. After dissection of the kidney, it was removed transvaginally. All data referring to patients were recorded and analyzed. The cosmetic result was evaluated according to the Patient Scar Assessment Questionnaire and Scoring System (PSAQ). Sexual function was investigated by administering the Female Sexual Function Index (FSFI). All 23 robotic transvaginal hybrid NOTES nephrectomy procedures were successfully completed without conversion to open surgery. The mean operative time was 188 min (range 120–330 min). The mean estimated blood loss was 216 ml (range 30–800 ml). The mean Visual Analog Scale (VAS) score at 24 h postoperatively was 2.4 (range 2–4), indicating minimal pain. The excellent cosmetic results were confirmed by the PSAQ score. Nineteen patients completed the FSFI questionnaire, and analysis did not show significant differences before and after surgery. One patient achieved spontaneous pregnancy 3 years after surgery and delivered successfully via the vaginal route. Robotic transvaginal hybrid NOTES nephrectomy is feasible, safe, and effective in properly selected patients, providing minimal postoperative pain and excellent cosmetic results.

Calcium kidney stone disease, a common urinary tract disorder characterized by a high recurrence rate, remains poorly understood in terms of its recurrent etiology. Existing preventive measures are inadequate, limiting their clinical utility. Recent evidence suggests a significant role for epigenetic modifications in stone formation. Based on expert-conducted PubMed literature searches, appropriate articles focusing on the investigation of epigenetic mechanisms in calcium kidney stone disease were carefully selected for inclusion in the study. The current understanding of calcium kidney stone disease indicates that epigenetic changes play a crucial role. Multiple studies have delved into the functions of DNA and mRNA methylation, histone and non-histone regulation, and non-coding RNA in the development of calcium kidney stones. Elucidating these molecular mechanisms holds promise for the development of more effective therapeutic and preventive strategies. Calcium kidney stone disease poses a challenge in clinical management due to its high recurrence rate and the suboptimal efficacy of existing preventive interventions. Although recent research has shed light on the role of epigenetic modifications in stone formation, further in-depth investigation is imperative. Continued exploration of epigenetic mechanisms will be essential for the development of more effective therapeutic and preventive strategies to improve the outcomes for patients with calcium kidney stone disease.

ObjectiveTo evaluate the feasibility, safety, and efficacy of local anesthesia applied to percutaneous nephrolithotomy (PCNL) under Enhanced Recovery After Surgery (ERAS) for treating upper urinary tract stones.Materials and methodsThis study was a prospective, single-center randomized controlled study in which the patients were randomly divided into two groups: 40 in the ERAS PCNL under local anesthesia (ERAS-LA) group and 40 in the ERAS PCNL under general anesthesia (ERAS-GA) group). The primary indicators were stone-free rate; the secondary outcomes were intraoperative and postoperative complications, intraoperative and postoperative VAS pain scores and postoperative stress response indicators. A meta-analysis was also performed using RevMan 5.4 software by searching relevant literatures in PubMed/Medline, Web of Science and Embase.ResultsThe stone clearance rates at 48 h were similar between the two groups [ERAS-LA: 85.0% (34/40) vs. ERAS-GA: 87.5% (35/40), P = 0.800] and both 90% at 1 month. The incidence of surgical complications was similar between the two group. The intraoperative pain score in ERAS-LA group was 2.90 ± 0.74, and the postoperative 24-h pain score was comparable between the two groups (ERAS-LA: 2.65 ± 1.35 vs. ERAS-GA: 2.63 ± 0.98, P = 0.925), with good pain control. The mean total operative time was lower in ERAS-LA group than in ERAS-GA group (68.15 ± 24.11 min vs. 82.125 ± 20.42 min, P = 0.006). Postoperative hemoglobin change values (3.38 ± 3.00 × 109/L vs. 5.22 ± 4.18 × 109/L, P = 0.027) and stress response factors including C-reactive protein (8.39 ± 7.46 mg/L vs. 10.47 ± 10.30 mg/L, P = 0.035) and interleukin-6 (5.40 ± 1.50 pg/ml vs. 10.57 ± 1.82 pg/ml, P = 0.041) were significantly lower in ERAS-LA group. The mean catheter retention, fistula retention, and postoperative hospital stay were all significantly lower in ERSA-LA group than in ERSA-GA group (2.3%, 2.9%, and 5.08 days vs. 3.33%, 4.38%, and 6.35 days, P < 0.05). The results of the meta-analysis were similar to that of our study.ConclusionsLocal anesthesia applied to ERAS-managed PCNL have a comparable stone clearance rates and complication rates, and a faster postoperative recovery, lower surgical stress, length of stay, anesthesia costs and hospital costs than general anesthesia.Clinical Trial Registrationhttp://www.medresman.org.cn, identifier (ChiCTR2100045681).

ObjectivesTo evaluate the safety and efficacy of sotn ureteroscope system with vacuum suctioning device for treating complicated steinstrasse.Materials and methodsThe medical records of 22 patients with complicated steinstrasse who underwent ureteroscopic lithotripsy via sotn ureteroscope system with vacuum suctioning device from January 2020 to March 2023 were summarized retrospectively. Five patients had ipsilateral renal calculi. The 11.5/12.5 F sotn ureteral access sheath (sotn-UAS) was placed below the lowermost section of the steinstrasse assisted by a 7.5/9.8 F standard ureteroscope, and then a 4.0/6.0 F console ureteroscope with laser fiber replaced the standard ureteroscope and was used for pulverizing the steinstrasse. The vacuum suctioning device was connected to the sotn-UAS for suctioning fragments and dusts.ResultAll procedures were successfully completed. The steinstrasse was free in 22 patients according to kidney-ureter-bladder radiography one day postoperatively. No intraoperative complications were observed. A total of four patients experienced postoperative complications, including one patient who experienced fever and was treated with antipyretics, one patient who experienced hematuria and was cured with hemostatic agents, and two patients who experienced urinary tract infection and needed only antibiotics. Five patients with ipsilateral renal calculi were treated with medical expulsive therapy or retrograde intrarenal surgery after steinstrasse surgery, and four of these patients achieved stone free status at the 3-month follow-up.ConclusionThe Sotn ureteroscope system with vacuum suctioning device is a feasible and safe treatment for complicated steinstrasse and provides satisfactory clinical outcomes.

ObjectiveExplore the clinical application value of urethral mucosal pretreatment at the tip of the prostate in preventing stress urinary incontinence (SUI) after thulium laser enucleation of the prostate (ThuLEP).MethodsEighty-seven patients with benign prostatic hyperplasia (BPH) treated with ThuLEP from June 2021 to December 2022 were divided into two groups. Of these, 42 patients (group A) underwent conventional ThuLEP and 45 patients (group B) were enucleated after pretreatment of the urethral mucosa. At the tip of the prostate, pretreatment of the urethral mucosa consisted of pushing the gland separately on both sides at the level of the verumontanum and cutting off the mucosa near the external urethral sphincter clockwise and counterclockwise. The perioperative and postoperative follow-up indicators [operation time, hemoglobin reduction, complications, Qmax, International Prostate Symptom Score (IPSS), quality of life (QoL), and post-void residual (PVR) volume] of the two groups of patients were collected and compared. All patients were followed up 1 month after surgery.ResultsAll 87 procedures were successfully completed. There was no significant difference in age and gland size between the two groups (P > 0.05). There was no significant difference between operating time and hemoglobin reduction in the two groups (P > 0.05). The Qmax, IPSS, QOL, and PVR volume were significantly improved postoperatively in both groups (P < 0.05). Temporary SUI occurred in both groups [12 cases (28.5%) in group A and 3 cases (6.7%) in group B (P < 0.05)]. There was no significant difference in the incidence of infection and urethral stricture between the two groups (P > 0.05).ConclusionPretreatment of the urethral mucosa before ThuLEP for BPH significantly reduces the incidence of SUI after surgery. This technique, which preconditions the apical urethral mucosa of the prostate, is safe and effective, has few complications, and is worthy of clinical application.

目的 系统评价坦索罗辛联合丁溴东莨菪碱在泌尿系结石体外冲击波碎石(ESWL)后辅助排石的效果及安全性.方法 计算机检索中国知网、万方、VIP、CBM、PubMed、Cochrane Library、Web of Science核心合集数据库,检索时限从建库至2022年4月,查找坦索罗辛联合丁溴东莨菪碱辅助ESWL治疗泌尿系结石的随机对照试验,试验组ESWL后给予坦索罗辛+丁溴东莨菪碱,对照组ESWL后给予丁溴东莨菪碱.采用RevMan 5.4软件进行meta分析,分析两组有效率、排石时间、肾绞痛消失时间、疼痛评分及不良反应情况,其中根据排石时间单位选择分为小时组、天数组;根据评分量表选择分为视觉模拟评分法(VAS)组、数字疼痛评分法(NPRS)组.结果 共纳入8篇文献,1 762例患者.试验组有效率高于对照组(RR=1.21,95％CI:1.16,1.26,P＜0.000 01).小时组排石时间短于对照组(SMD=-5.50,95％CI:-6.59,-4.41,P＜0.00001).天数组排石时间短于对照组(SMD=-4.21,95％CI:-6.40,-2.03,P=0.000 2).试验组肾绞痛消失时间短于对照组(SMD=-2.04,95％CI:-2.18,-1.91,P＜0.00001).VAS组疼痛程度低于对照组(SMD=-0.65,95％CI:-0.90,-0.39,P＜0.000 01).NPRS组疼痛程度低于对照组(SMD=-1.59,95％CI:-1.80,-1.38,P＜0.000 01).两组不良反应比较,差异无统计学意义(P＞0.05).结论 坦索罗辛联合丁溴东莨菪碱辅助ESWL治疗泌尿系结石可以提高治疗的有效率,促进结石排出、缩短疼痛时间及减轻患者疼痛症状,是一种安全有效的方法.

ObjectivesWe aimed to probe the safety and effectiveness of flexible ureteroscopic lithotripsy (FURL) with a suctioning ureteral access sheath (S-UAS) for removing upper urinary calculi under local anesthesia (LA).Materials and methodsThe clinical data of 56 patients with upper urinary calculi treated by FURL with an S-UAS under LA during the period between September 2019 and November 2022 were analyzed retrospectively. For LA, intramuscular pethidine (1.0–2.0 mg/kg) and phenergan (25 mg) were administered 30 min prior to surgery, and oxybuprocaine hydrochloride gel was administered through the urethra at the start of the surgery. The S-UAS and flexible ureteroscope were used for FURL. Demographic characteristics, stone-related parameters, and clinical outcomes were analyzed.ResultA total of 66 procedures were performed successfully on 46 patients (Group A), who underwent unilateral surgeries, and on 10 patients (Group B) who underwent same-session bilateral surgeries. All 56 patients were operated upon without altering the anesthesia strategy, and none required additional analgesia. The mean stone sizes of the Group A and Group B patients were 20.24 ± 5.45 mm and 29.40 ± 3.89 mm, respectively. The mean operative times of the two groups were 53.04 ± 13.35 min and 90.00 ± 15.81 min, respectively. In Group A, the stone-free rates (SFRs) were 76.1% (35/46) and 85.1% (40/46) at postoperative day 1 and day 30, respectively. In Group B, the SFRs were 80.0% (16/20) and 85.0% (17/20), respectively. Four (8.7%) patients in Group A suffered complications such as fever, stent pain, urosepsis, and steinstrasse. In Group B, one (10%) patient suffered from fever.ConclusionFURL, combined with an S-UAS under LA, is a feasible option and provides satisfactory clinical outcomes for appropriately selected patients.

To compare the safety and efficacy of novel tip-flexible suctioning ureteral access sheath (NTFS-UAS) and traditional ureteral access sheath (T-UAS) combined with flexible ureteroscope for treating unilateral renal calculi. The clinical data of 214 patients with unilateral renal calculi treated by NTFS-UAS (n = 102) and T-UAS (n = 112) combined with flexible ureteroscope from August 2021 to April 2022 were analyzed retrospectively. Demographic characteristics, stone-related parameters, operative time, stone-free rates (SFR), hospitalization time and complication rate (CR) were analyzed. No significant difference was observed between the two groups in terms of demographic characteristics, stone-related parameters, intraoperative CR, and hospitalization time. The operative time of NTFS-UAS group was significantly shorter than T-UAS group (55.25 ± 11.42 min vs. 59.36 ± 15.59 min; P = 0.028). The NTFS-UAS group obtained significantly higher SFR on 1 day postoperatively (86.3

目的 探讨末端可弯输尿管吸引鞘联合输尿管软镜治疗上尿路结石的安全性和有效性.方法 回顾性分析2022 年2～8 月采用末端可弯输尿管吸引鞘联合输尿管软镜治疗75 例上尿路结石的资料.肾结石57 例,输尿管上段结石12例,肾结石合并输尿管上段结石6 例.左侧31 例,右侧36 例,双侧8 例.结石长径(18.7±5.2)mm,CT值(1052.4±288.6)HU.结果 75 例手术均顺利,术中均未发生严重并发症.手术时间(58.6±13.6)min,术后住院时间(2.9±1.0)d.术后第1 天结石清除率86.7%(65/75),术后 30 天结石清除率 93.3%(70/75).术后并发症 5 例,包括感染性休克 1 例,发热 3例,血尿1 例,均治愈.结论 末端可弯输尿管吸引鞘联合输尿管软镜治疗上尿路结石安全、可行,疗效确切.

Percutaneous nephrolithotomy is generally performed under general or regional anesthesia; however, it is rarely performed under local infiltration anesthesia (LIA). This study aimed to assess the safety and effectiveness of Chinese mini percutaneous nephrolithotomy (MPCNL) for upper urinary calculi under LIA. A retrospective analysis of 52 patients with upper urinary stones who underwent MPCNL under LIA from April 2019 to May 2022 was performed. Pethidine and Phenergan were intramuscularly injected 30 minutes preoperatively. Oxybuprocaine hydrochloride gel was applied to the urethra for lubricating and mucosal anesthesia. Ropivacaine hydrochloride and lidocaine were injected into the whole percutaneous channel for local anesthesia. An 8/9.8F ureteroscope and an 18F vacuum-assisted access sheath were applied in MPCNL. All 52 patients tolerated procedures and underwent operations successfully; none of them converted the anesthesia method or required additional analgesia. The mean visual analogue scale scores intraoperatively and at 6 hours, 24 hours, and 48 hours after surgery were 3.25 ± 0.52, 3.13 ± 0.69, 2.25 ± 0.56, and 1.58 ± 0.50, respectively. The stone free rate was 84.6%. Complications were seen in 6 (11.5%) patients, including fever in 2 patients (Clavien I), renal colic in 1 patient (Clavien I), clinically insignificant bleeding in 2 patients (Clavien I), and urinary tract infection in 1 patient (Clavien II). No severe complications were observed in any patients. Chinese MPCNL under LIA was a feasible option and achieved good outcomes in appropriately selected patients, and it may become the routine procedure for general patients.

Abstract Background Acute lymphoblastic leukemia (ALL) has the highest incidence among childhood hematologic cancers. Exposure to certain cytotoxic therapies for ALL is correlated with a higher risk of secondary malignancies. Case We report a rare case of a 6‐year‐old girl being diagnosed with secondary acute myeloid leukemia (AML) during her maintenance phase of treatment for ALL with TEL‐AML1 fusion gene, approximately 17 months after the primary diagnosis. Conclusion This case indicates that we should recognize the increased risk of secondary AML for pediatric ALL patients with TEL‐AML1 fusion gene if multiple alkylating drugs and inhibitors for topoisomerase II are included in induction chemotherapy.

目的 对比分析硕通镜与软性输尿管镜治疗输尿管上段结石的临床疗效.方法 选取80例输尿管上段结石患者作为研究对象,采用随机数字表法将其分为硬镜组(n=38)和软镜组(n=42).硬镜组采用硕通镜碎石术治疗,软镜组采用软性输尿管镜碎石术治疗.比较两组手术时间、术后住院时间、Ⅰ期进镜成功率、术后1个月无石率、术后并发症发生率等指标.结果 两组患者均顺利完成手术.硬镜组手术时间短于软镜组,Ⅰ期进镜成功率、术后1个月无石率高于软镜组(均P＜0.05),但两组患者术后住院时间差异无统计学意义(P＞0.05).硬镜组术中输尿管损伤、术后1 d结石上移、术后24 h发热、术后24 h尿源性脓毒血症发生率均低于软镜组(均P＜0.05).结论 与软性输尿管镜碎石术相比,采用硕通镜碎石术治疗输尿管上段结石的手术时间更短、术后无石率更高、并发症更少,值得临床推广应用.

目的:总结局麻下输尿管软镜碎石术治疗高危上尿路结石患者的经验,评价其可行性、安全性及有效性.方法:选取2019年3月至2021年3月我院泌尿外科实施局麻下输尿管软镜碎石术治疗高危上尿路结石患者15例.术前麻醉风险评估ASAⅢ级10例,ASAⅣ级5例.单侧肾结石8例,单侧输尿管上段结石4例,单侧肾及输尿管上段结石1例,双侧肾结石2例;结石大小0.8～3.0 cm,平均1.7 cm.术前患侧留置双J管1周以上,术中采用奥布卡因凝胶行尿道麻醉,2％利多卡因注射液行膀胱和输尿管麻醉,随后行输尿管软镜碎石术.记录手术时间、术中疼痛视觉模拟评分(VAS)、术后血红蛋白下降值、手术并发症、结石清除率、术后住院时间等指标.结果:15例患者共行20次局麻软镜碎石术,患者耐受性均良好,无患者因疼痛终止手术,其中2例双肾结石分期行手术,1例单侧肾及输尿管上段结石先后行2次手术,1例孤立肾肾结石负荷大先后行3次手术.手术时间(59.2±14.0)min,术中VAS评分(1.8±0.6)分;术后血红蛋白下降值(9.5±8.7)g·L-1.术后发热1例,脓毒血症1例,均治疗后痊愈,无死亡病例;术后住院时间为(3.2±1.5)d.术后1个月结石清除率为86.7％(13/15).结论:局麻下输尿管软镜碎石术治疗全麻高危患者合并上尿路结石安全、可行、有效.

You have accessJournal of UrologyCME1 May 2022PD04-07 ANALYSIS OF HIGH-RISK FACTORS FOR ADRENAL CRISIS AFTER ADRENAL SURGERY Quanliang Liu, Yuhua Zou, Xiaofeng Zou, Guoxi Zhang, Yuanhu Yuan, Rihai Xiao, Gengqing Wu, Biao Qian, Xiaoning Wang, and Hui Xu Quanliang LiuQuanliang Liu More articles by this author , Yuhua ZouYuhua Zou More articles by this author , Xiaofeng ZouXiaofeng Zou More articles by this author , Guoxi ZhangGuoxi Zhang More articles by this author , Yuanhu YuanYuanhu Yuan More articles by this author , Rihai XiaoRihai Xiao More articles by this author , Gengqing WuGengqing Wu More articles by this author , Biao QianBiao Qian More articles by this author , Xiaoning WangXiaoning Wang More articles by this author , and Hui XuHui Xu More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002519.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: To summarize the clinical characteristics, diagnosis and treatment experience of secondary adrenal crisis after adrenal tumor resection, and to explore its related risk factors. METHODS: The clinical data of 235 patients undergoing adrenal tumor resection in theDepartment of Urology of the First Affiliated Hospital of Gannan MedicalUniversity from January 2015 to April 2021 were retrospectively analyzed.Logistic regression was used to analyze the related risk factors of adrenalcrisis after adrenalectomy.This study was approved by the Hospital Ethics Committee. RESULTS: The age ranged from 21 to65 years (mean 47 years). 136 males and 99 females. Among them, 149 casesunderwent retroperitoneal laparoscopic adrenalectomy, 69 cases underwenttransabdominal laparoscopic adrenalectomy, and 17 cases underwentrobot-assisted laparoscopic adrenalectomy. Among them, 80 cases were cortisoladenoma, 4 cases were adrenalcortical carcinoma, 115 cases were aldosteroneadenoma, 26 cases were pheochromocytoma, and 10 cases were bilateral adrenalcortical hyperplasia. The diameter of the tumor was 1.5-11 cm, including 16patients with adrenal crisis (9 males and 7 females). Logistic regressionanalysis showed that age, tumor size, operation side, operation mode, operationtime and intraoperative blood loss had no significant correlation with theoccurrence of adrenal crisis. Preoperative infection, adrenal cortical tumor,preoperative ACTH level, preoperative blood glucose abnormality, intraoperativenon-preventive corticosteroids and previous history of adrenal crisis were highrisk factors for adrenal crisis after adrenal tumor operation. CONCLUSIONS: Adrenal crisis is morelikely to occur after adrenal tumor resection in patients with preoperativeinfection, adrenal cortical tumors and low levels of ACTH, diabetes andprevious history of adrenal crisis. Postoperative vital signs should be closelyobserved and hormones should be supplemented in time to avoid adverse events. Source of Funding: National Natural Science Foundation of China (81860456, 81760462) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e51 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Quanliang Liu More articles by this author Yuhua Zou More articles by this author Xiaofeng Zou More articles by this author Guoxi Zhang More articles by this author Yuanhu Yuan More articles by this author Rihai Xiao More articles by this author Gengqing Wu More articles by this author Biao Qian More articles by this author Xiaoning Wang More articles by this author Hui Xu More articles by this author Expand All Advertisement PDF downloadLoading ...

目的:探讨硕通镜治疗输尿管石街的临床疗效.方法:回顾性分析2018年3月-2020年3月在我院采用硕通镜下钬激光碎石术治疗输尿管石街患者的临床资料.患者共12例,男8例,女4例;年龄25～62岁,中位年龄44岁;输尿管石街长5.2～10.8 cm,平均7.4cm.观察一期手术成功率、手术时间、结石清除率、术中及术后并发症发生情况.结果:12例患者均一期顺利完成手术,手术时间40～100 min,平均60 min,术中未发生肾盂输尿管黏膜穿孔、撕脱、断裂以及大出血、感染性休克等严重并发症.术后住院时间1～3 d,平均1.5d,1例术后出现发热,对症治疗后痊愈,无其他术后并发症发生.术后第1天和术后1个月的清石率分别为83％和92％.术后1个月均顺利拔除双J管,复查彩超肾积水较术前减轻,未见肾周积液及血肿形成.复查肾功能较术前改善.结论:硕通镜治疗输尿管石街安全、有效.

目的 评价超选择性髂内动脉栓塞术治疗晚期前列腺癌合并难治性出血的安全性及疗效.方法 应用弹簧钢圈及聚乙烯醇颗粒,对2例晚期前列腺癌合并难治性出血患者进行超选择性髂内动脉栓塞术,观察其临床疗效.结果 本组2例超选择性髂内动脉栓塞术均获成功,术后出血症状明显改善,持续监测血红蛋白、红细胞压积保持平稳,分别随访44、4个月,无再发严重出血.结论 超选择性髂内动脉栓塞术治疗晚期前列腺癌难治性出血安全、有效,值得临床选用.

总结耻骨上机器人辅助经脐双通道腹腔镜巨大嗜铬细胞瘤/副神经节瘤(pheochromocytoma and paraganglioma,PPGL)切除术的经验与体会,探讨其安全性和可行性.回顾性分析2019年8月-2020年3月我院施行的5例耻骨上机器人辅助经脐双通道腹腔镜巨大PPGL切除术的临床资料.男4例,女1例,中位年龄45.5(26～57)岁,中位BMI 23.4(20.4～24.8) kg/m2.中位收缩压142(115～220) mmHg,中位舒张压106(78～140) mmHg,中位心率98(72～114)次/min.伴有高血压病史3例,其中1例曾有脑梗死病史;其余2例无特异性症状,为体检时发现.肿瘤位于右肾上腺区3例,左肾上腺区1例,左肾门部1例;中位肿瘤最大径6.5(6.0～8.3) cm.术前中位24 h尿多巴胺896.4(650.7～1 236.3) μg/24 h,中位24 h尿去甲肾上腺素450.7(114.6～775.8) μg/24 h,中位24 h尿肾上腺素66.5(45.6～114.8) μg/24 h,均升高.记录手术时间、出血量及住院时间等指标.本组5例手术均顺利完成,无中转开放或普通腹腔镜手术.中位手术时间115(75～165) min,中位术中估计失血量90(50～180) mL.术中、术后均未发生严重并发症,均未输血.所有患者术后恢复顺利.术后24 h中位视觉模拟疼痛评分(VAS)2(1～3)分,术后第1～2天下床活动,术后第2～3 d拔除腹腔引流管.中位术后住院时间4(3～6)d.术后病理诊断:嗜铬细胞瘤3例,副神经节瘤2例.所有患者均获随访,中位随访时间5(2～9)个月.切口愈合良好,脐部瘢痕因被脐部皱褶遮蔽而不明显,耻骨上切口被阴毛遮蔽而不易察觉;无肿瘤复发;24 h尿儿茶酚胺均恢复正常;术前3例血压升高者,术后血压均恢复正常2例,1例仍需口服降压药治疗,但药量减少且血压控制良好.耻骨上机器人辅助经脐双通道腹腔镜巨大PPGL切除手术安全、可行,且美容优势显著,值得临床应用.

目的:分析经皮肾微造瘘顺行灌注法在输尿管镜治疗输尿管上段结石中的应用效果.方法:选择2016-01 ～ 2019-12于我院泌尿外科实施输尿管镜碎石治疗的输尿管上段结石患者90例,采用随机数字表法分为两组,每组各45例.对照组行传统输尿管镜碎石,试验组行经皮肾微造瘘顺行灌注碎石,比较两组碎石效果、手术指标及并发症发生情况.结果:试验组完全清石率为97.78％,高于对照组的80.00％,结石漂移率为4.44％、术后并发症发生率为4.44％,低于对照组的22.22％、17.78％,差异有统计学意义(P＜0.05);试验组手术时间(35.04±3.69) min,短于对照组的(39.79±3.55) min,术中出血量(65.32 +9.36)mL,少于对照组(84.22±12.48)mL,差异有统计学意义(P＜0.05);两组住院时间相比,差异无统计学意义(P＞0.05).结论:经皮肾微造瘘顺行灌注法在输尿管镜治疗输尿管上段结石中的应用效果确切,完全清石率较高,能够降低结石漂移率,减少术中出血量,降低术后发热发生率,利于患者术后恢复.

目的 探讨二氧化碳(CO2)气相软性输尿管镜治疗肾结石的应用研究.方法 对2例诊断为单侧肾结石的患者行CO2气相软性输尿管镜碎石术,2例患者术前均未留置双J管,故先应用输尿管硬镜行患侧输尿管镜检查术,未见异常后留置斑马导丝,沿斑马导丝置入12F软性输尿管镜导入鞘(以下简称软镜鞘),应用电子软性输尿管镜置入软镜鞘,在软镜灌注接口连接气腹机,向肾盂内灌注CO2气体,压力设置为10-12mmHg,运用钬激光光纤在CO2气相环境中进行碎石.结果 软性输尿管镜在CO2气相环境中视野清晰度尚可,镜检寻及结石后开始碎石,碎石约10min后,出现气液混合界面,视野逐渐不清,无法继续手术,立即改为注射器推注生理盐水后顺利完成手术,手术时间分别为47min和55min,未发生出血,穿孔,感染等的并发症.结论 CO2气相软性输尿管镜碎石术为一种新型的碎石技术,初期视野清晰,但随着碎石进行,逐渐出现气液混合界面,导致视野不清,在临床上有一定的应用价值,但需进一步改进设备和技术.

Accurate prediction is highly important for clinical decision making and early treatment. In this paper, we study the imbalanced data problem in prediction, a key challenge existing in the healthcare area. Imbalanced datasets bias classifiers towards the majority class, leading to an unsatisfied classification prediction performance on the minority class, which is known as imbalance problem. Existing imbalance learning methods may suffer from issues like information loss, overfitting, and high training time cost. To tackle these issues, we propose a novel ensemble learning method called Multiple bAlance Subsets Stacking (MASS) by exploiting a multiple balance subsets construction strategy. Furthermore, we improve MASS with introducing parallelism (Parallel MASS) to reduce the training time cost. We evaluate MASS on three real-world healthcare datasets, and experimental results demonstrate that its prediction performance outperforms the state-of-art methods in terms of AUC, F1-score and MCC. Through the speedup analysis, Parallel MASS reduces the training time cost greatly on large dataset, and its speedup increases as the data size grows.