患者，男，33岁，因"体检发现右肾占位一个月余"入院，病程中无特殊不适。既往频发室早15年，未治疗。查体无明显异常。腹部CT示：右肾上极异常强化灶，约2.4 cm×2.6 cm，内见少许分隔及结节状强化（图1）。诊断：右肾上极囊实性占位（Bosniak IV级）。完善检查后行机器人辅助腹腔镜下右肾部分切除术，术中见肿瘤位于右肾上极直径约2.5 cm，阻断肾动脉后沿肿瘤包膜外0.5 cm完整切除肿瘤，肾动脉阻断时间约23 min。病理：后肾腺瘤。免疫组化：CK（+），EMA（-），CK5/6（-），P63（-），CK7（-），CK20（-），CA-IX（+），CD117（-），CD10（-），P504s（-），E-cad（+），CK19（局灶+），Ki-67（2%+），TFE3（-），Vim（+）。患者术后恢复良好，随访两年无复发及转移。

目的 探讨通过关闭经腹腔入路腹腔镜根治性膀胱切除+回肠通道术(Bricker)中形成的腔隙来防止腹内疝形成以减少术后肠梗阻发生率的手术技术改良.方法 报告和分析两组病例的临床资料.在标准腹腔镜下根治性全膀胱切除+盆腔淋巴结清扫术后建立回肠通道,2018 年 10 月—2022 年 2 月的 41 例患者在开放或腹腔镜下将右内侧腹膜与回肠通道系膜缝合,并覆盖于回肠通道末端,封闭右内侧腹膜、输尿管与回肠通道系膜之间的间隙,使回肠通道末端与双侧输尿管均腹膜外化(常规组).2022 年 2 月—2022 年 12 月的 15 例患者除了缝合封闭右内侧腹膜、输尿管和回肠通道系膜间隙外,还在回肠通道下方将右内侧腹膜与右外侧腹膜缝合,将回肠通道和右侧腹壁之间的间隙进行"兜底"(改良组).分析两组术后肠道功能恢复情况及肠梗阻发生率.结果 常规组 41 例患者术后 2～6 d恢复肠道功能,中位通气时间 3d,3 例患者出现术后肠梗阻,经胃肠减压、灌肠等保守治疗后 2 例好转,1 例保守治疗无效后行手术探查.改良组 15 例患者,排气排便时间与常规组无差异,但是改良组术后没有出现肠梗阻的病例.结论 回肠通道末端腹膜外化可减少腹内疝发生率和术后肠梗阻的发生,具有一定的临床推广价值.

OBJECTIVES:To evaluate the feasibility and safety of bipolar-plasmakinetic transurethral enucleation and resection of the prostate (B-TUERP) in day surgery.METHODS:From January 2021 to August 2022, 34 patients with benign prostatic hyperplasia (BPH) underwent B-TUERP in day surgery in the First Affiliated Hospital of Anhui Medical University. Patients completed the screening and anesthesia evaluation before admission and received the standard surgery which implements "anatomical enucleation of the prostate" and "absolute bleeding control" on the same day of admission, and by the same doctor. Bladder irrigation was stopped, catheter was removed and the discharge evaluation was performed on the first day after operation. The baseline data, perioperative conditions, time of recovery, treatment outcomes, hospitalization costs, and postoperative complications were analyzed.RESULTS:All operations were successfully conducted. The average age of the patients was (62.2±7.8) years, average prostate volume was (50.2±29.3) mL. The average operation time was (36.5±19.1) min, the average hemoglobin and blood sodium were decreased by (16.2±7.1) g/L and (2.2±2.0) mmol/L, respectively. The average postoperative length of hospital stay, and total length of hospital stay were (17.7±2.2) and (20.8±2.1) h, respectively, and the average hospitalization cost was (13 558±2320) CNY. All patients were discharged on the day after surgery except for one patient who was transferred to a general ward. Three patients received indwelling catheterization after catheter removal. The 3-month follow-up results showed a substantial improvement in the International Prostate Symptom Score, quality of life score and maximum urinary flow rate (all P<0.01). Three patients experienced temporary urinary incontinence, 1 patient experienced urinary tract infection, 4 patients were diagnosed with urethral stricture and 2 patients experienced bladder neck contracture. No complications above Clavien grade Ⅱ occurred.CONCLUSIONS:The preliminary results showed that B-TUERP ambulatory surgery is a safe, feasible, economical and effective treatment for appropriately selected patients with BPH.

前列腺癌根治术是治疗局限性及局部进展期前列腺癌最有效的方法之一,术后切缘阳性是经常发生的问题,有可能导致根治术后的生化复发甚至临床进展,但在国内切缘阳性的问题尚未引起足够的重视.本文旨在总结前列腺癌根治术后切缘阳性患者的最新诊疗进展,为预防和治疗此类患者提供思路.

目的 了解从事宫颈癌防治的医务人员对人乳头瘤病毒(human papilloma virus,HPV)及其疫苗知识、态度、行为现状,为今后开展宫颈癌防控工作提供依据.方法 调查安徽省349名从事宫颈癌防治的医务人员HPV及其疫苗知信行情况,采用自行设计调查问卷开展调查,使用R Studio软件处理调查数据.结果 医务人员HPV及其疫苗知识得分中位数为11(10,12)分,不同性别、职称、文化程度、工作单位及科室的调查对象得分差异有统计学意义(P值均＜0.05);94.27％(329/349)的调查对象认为HPV疫苗对预防宫颈癌有效,93.70％(327/349)的调查对象赞同将HPV疫苗纳入常规疫苗,91.40％(319/349)调查对象认为HPV疫苗安全;96.56％(337/349)的调查对象向亲友推荐接种HPV疫苗,95.13％(332/349)调查对象主动学习HPV及其疫苗相关知识,94.84％(331/349)调查对象在日常工作中主动向他人介绍HPV疫苗.结论 安徽省部分从事宫颈癌防治的医务人员对HPV及其疫苗知识的总体认知水平较高,大多数医务人员持有积极的态度并有正确的预防行为,但不同性别、职称、文化程度、工作单位及科室的医务人员对HPV及其疫苗知识的知信行有所差别,应开展精准的健康教育,促进宫颈癌防控工作.

Telemedicine is the process of using telecommunications and digital relay to perform, teach, or share medical knowledge, including telementoring, telesurgery and telerobotics. Telemedicine in surgery could not only help to solve the problem of shortage of high-level surgeons, but also eliminate geographical obstacles, relieve economic burden of patients, contribute to the national implementation of hierarchical diagnosis and treatment. The history and current situation of telemedicine at home and abroad in the field of urological surgery are reviewed in this article, and future development of telemedicine is prospected.

目的 创新性使用450 nm半导体蓝激光联合曲安奈德激素注射治疗膀胱颈挛缩(BNC),评估该治疗方案的有效性和安全性.方法 对安徽医科大学第一附属医院的1例61 岁男性BNC患者行450 nm半导体蓝激光气化术联合曲安奈德激素注射治疗,患者同时合并有尿道狭窄,手术通过一种F22 的小口径激光电切镜操作完成,报告术后3个月随访结果.结果 手术顺利,手术时间30 min,患者术后第2天出院.术后3个月随访结果:患者最大尿流率(Qmax)为22.1 mL/s,术后国际前列腺症状评分(IPSS)为2分,生活质量指数(QoL)评分为0分,无BNC及尿道狭窄复发.结论 450 nm半导体蓝激光联合曲安奈德激素注射治疗BNC安全可行,通过F22 的小口径激光电切镜操作同样安全可行,并对合并尿道狭窄的患者尤显必要.术后3个月的短期随访结果满意.

Objective:To analyzed the urinary microbiota characteristics of upper tract urothelial carcinoma(UTUC) patients.Methods:Urine samples were collected from 23 patients with UTUC (UTUC group) and 22 patients with benign diseases (control group) admitted to Yijishan Hospital, the First Affiliated Hospital of Wannan Medical College from July 2021 to July 2022. The differences in age [(60.9±5.7) years vs. (61.4±8.8) years], sex (male/female: 15/8 vs. 9/13), and body mass index [(22.9±1.8) kg/m 2 vs. (23.4±1.7) kg/m 2] between the UTUC group and the control group were not statistically significant ( P>0.05). The V4 region of the 16S rRNA of urinary microorganisms was sequenced using the Illumina NovaSeq6000, and the results were processed using QLLME2. Differences in α-diversity between groups were analyzed by using the Shannon, Simpson, and Chao1 indices. Differences in β-diversity between groups were analyzed by using unweighted principal coordinates analysis (PCoA). Linear discriminant analysis Effect Size(LEfSe)was used to identify the bacterial taxa with different abundances between groups. Significant differences were defined as LDA>2. Results:The Chao1 index (703.12±265.54 vs. 506.20±214.02) and Shannon index (5.61±1.85 vs. 5.07±1.34) were significantly higher in the UTUC group compared to that in the control group ( P<0.05). The α-diversity of urinary microbes was elevated in the UTUC group compared to that in the control group but the difference in β-diversity was not statistically significant ( P=0.161). The enrichment of Bacteroidaceae, Ruminococcaceae, Acidaminococcaceae, Thermaceae, Erysipelatoclostridiaceae, and Coriobacteriaceae abundance was higher in the urine of UTUC patients(LDA > 2). Further subgrouping analyses of the UTUC patients showed that the differences in Chao1 index (706.44±271.84 vs. 784.09±272.72), Shannon index (6.04±1.30 vs. 5.91±1.67), and Simpson index (0.94±0.08 vs. 0.89±0.22) between the muscle-invasive group and the non-muscle-invasive group were not statistically significant ( P>0.05). The difference in α-diversity between muscle-invasive and non-muscle-invasive group was not statistically significant, but the difference in β-diversity was statistically significant ( P=0.047). The urinary microbial communities of Gammaproteobacteria, Cutibacterium, Rhodococcus and Nocardiaceae were enriched in muscle-invasive group and differed from that in non-muscle-invasive group(LDA>2). Conclusions:This study suggests that the urinary microbial community was more abundant in UTUC patients than in non-UTUC patients and that Bacteroidaceae, Ruminococcaceae, Acidaminococcaceae, Thermaceae, Erysipelatoclostridiaceae, and Coriobacteriaceae were more abundant in the urine of UTUC patients. The urinary microbial community was more abundant in the urine of non-muscle-invasive patients than in the muscle-invasive patients, and Gammaproteobacteria, Cutibacterium, Rhodococcus and Nocardiaceae were more abundant in the urine of non-muscle-invasive patients.

慢性前列腺炎是泌尿男科常见病之一.美国国立卫生研究院(NIH)前列腺炎分型中的Ⅲ型前列腺炎即慢性前列腺炎/慢性盆腔疼痛综合征的概念不能反映疾病本质,如病因与发病机制不明确、临床表现多样、诊断依据不足等;Ⅲ型前列腺炎的概念未将盆底和下尿路视为功能性整体.因此,中国慢性前列腺炎诊断标准与疗效评判协作组建议将Ⅲ型前列腺炎更名为前列腺盆腔综合征,探索建立以症状为核心的诊断及疗效评价标准,以能反映疾病本质、符合Ⅲ型前列腺炎患者以改善症状和提高生活质量为主的治疗目标.新理论的提出及多中心临床试验的开展将有助于泌尿外科医师加深对前列腺盆腔综合征的认识及理解,更有助于对该综合征的正确诊断和治疗.

Laparoscopic renal pedicle lymphatic disconnection is the most effective method for treating chyluria that has failed to respond to conservative management. Chylous hemothorax is a rare clinical occurrence resulting from the anatomic abnormality. This paper reported a case, who was admitted with painless gross hematuria for 1 month and was diagnosed with left chylous hematuria. Laparoscopic left renal pedicle lymphatic disconnection was performed, and bilateral chylous hemothorax occurred after the operation. After conservative treatment such as bilateral closed thoracic drainage and blood transfusion support, the patient recovered well. After 2 months of follow-up, there was no obvious effusion in the bilateral thoracic cavity, and the chylous test of urine fluid was negative.

尿失禁是前列腺癌根治术(RP)最受关心的并发症之一,机器人手术为RP提供了多种入路和术式选择,盆底结构(神经、血管、肌肉、筋膜等)保留和重建是尿控功能的重要基础,机器人手术为结构保留和重建提供了更好的保障.相比开放和腹腔镜手术,机器人手术优势显著,我们国家的泌尿外科专家也有诸多的研究成果,但是某些细节存在不清晰甚至争议.我们在此编写尿控功能保留专家共识,供同道们参考,尤其有利于初学者和青年医师学习.

外科手术是公认的治疗良性前列腺增生(benign prosta-tic hyperplasia, BPH)疗效最好的方案.经尿道前列腺电切术(transurethral resection of the prostate, TURP)至今仍是BPH外科治疗的标准术式[1].然而,该术式存在腺体残留易复发、大出血需输血、电切综合征甚至死亡等严重并发症,且这些并发症会随着前列腺体积增大而增加.

目的 探讨体检成年男性良性前列腺钙化(BPC)的影响因素,为开展患者教育及进一步探讨BPC对前列腺的不良影响提供参考.方法 回顾性分析2018年10月至2021年6月体检成年男性的详细体检资料,按是否BPC分组,单因素比较两组间的体检指标,多因素分析BPC的影响因素.结果 3433名中位年龄38岁体检成年男性中发现BPC者770例.非BPC组年龄、收缩压和前列腺体积低于BPC组(P<0.05),身高、血尿酸高于BPC组(P<0.05);高血压患者数低于BPC组(P<0.05).多因素Logistic分析显示年龄(OR=1.026,95％CI:1.018-1.035)、身高(OR=0.982,95％CI:0.967-0.997)、前列腺体积(OR=1.039,95％CI:1.026-1.053)、高血压(OR=1.268,95％CI:1.064-1.512)和行业(尤其教育文化和医疗卫生)(OR=1.556,95％CI:1.178-2.055和OR=1.435,95％CI:1.017-2.024)是BPC的独立影响因素.结论 年龄、身高、前列腺体积、高血压和从事教育文化或医疗卫生的行业是BPC的影响因素.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is one of the common diseases in uroloandrology, which recurs easily after treatment. In recent years, the safety and efficacy of extracorporeal shock wave therapy (ESWT) for CP/CPPS has been widely demonstrated. Studies have shown satisfactory short-term (≤12 weeks) outcomes of ESWT, but lack long-term (>12 weeks) follow-up data. In addition, inconsistent indications and unexplained therapeutic mechanisms have limited the further clinical promotion of ESWT. This article summarizes the latest progress and potential mechanism of ESWT in the treatment of CP/CPPS in order to provide new insights for the standardized application of ESWT.

The clinical outcome of heterogeneous bladder cancer (BCa) is impacted by varying molecular characteristics and clinical features, and new molecular classification is necessary to recognize patients with dichotomized prognosis. We enrolled a total of 568 BCa patients from the TCGA-BLCA and GSE13507 cohorts. A total of 107 candidate genes, which were mostly involved in the extracellular matrix-associated pathway, were first selected through the consensus value of the area under the receiver operating characteristic curve (AUC). Furthermore, absolute shrinkage and selection operation regression analysis was implemented to reveal the 15 genes and establish the prognostic signature. The newly defined prognostic signature could precisely separate BCa patients into subgroups with favorable and poor prognosis in the training TCGA-BLCA cohort (p < 0.001, HR = 2.41, and 95% CI: 1.76-3.29), as well as the testing GSE13507 cohort (p < 0.001, HR = 7.32, and 95% CI: 1.76-3.29) and external validation E-MTAB-4321 cohort (p < 0.001, HR = 10.56, 95% CI: 3.208-34.731). Multivariate Cox analysis involving the signature and clinical features indicated that the signature is an independent factor for the prediction of BCa prognosis. We also explored potential targeted therapy for BCa patients with high- or low-risk scores and found that patients with high risk were more suitable for chemotherapy with gemcitabine, doxorubicin, cisplatin, paclitaxel, and vinblastine (all p < 0.05), but anti-PD-L1 therapy was useless. We knocked down HEYL with siRNAs in T24 and 5,637 cells, and observed the decreased protein level of HEYL, and inhibited cell viability and cell invasion. In summary, we proposed and validated a 15-top-prognostic gene-based signature to indicate the dichotomized prognosis and response to targeted therapy.

Objective:To explore the preliminary experiences of using wireless intelligent endoscopy system in urology of primary hospital.Methods:The clinical data of 21 patients undergone urological surgery in Suixi Hospital from July 2021 to August 2021 were analyzed retrospectively, including 2 cases of laparoscopic radical prostatectomy, 2 cases of laparoscopic radical nephrectomy and 2 cases of laparoscopic renal cyst decapitation decompression, 6 cases of transurethral resection of prostate, 2 cases of transurethral resection of bladder tumor, 3 cases of percutaneous nephrolithotomy, and 4 cases of transurethral ureteroscopic holmium laser lithotripsy. The operation time, intraoperative bleeding, postoperative recovery ventilation time and operation-related complications were analyzed.Results:The operation was successful in 21 patients. The operative time was 45-175 min, and the blood loss was 10- 150 ml. The time of transurethral surgery was 22-127 min. The operative time of percutaneous nephrolithotomy wsa 70-145 min. The intestinal ventilation function was restored 1-2 days after operation, and there were no postoperative complications after follow-up for 1 month.Conclusion:The application of wireless intelligent endoscopy system in primary hospital provides a clear picture and good anatomical level, with advantages of less bleeding, rapid recovery, less complications, easily carrying, and has a popularization prospect in remote diagnosis and treatment. However, the conclusion still needs large sample size, multi-center research and long-term follow-up for further verification.

Chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) is a very common urological disorder and has been gradually regarded as an immune-mediated disease. Multiple studies have indicated that the gut microflora plays a pivotal part in immune homeostasis and autoimmune disorder development. However, whether the gut microflora affects the CP/CPPS, and the underlying mechanism behind them remain unclear. Here, we built an experimental autoimmune prostatitis (EAP) mouse model by subcutaneous immunity and identified that its Th17/Treg frequency was imbalanced. Using fecal 16s rRNA sequencing and untargeted/targeted metabolomics, we discovered that the diversity and relative abundance of gut microflora and their metabolites were obviously different between the control and the EAP group. Propionic acid, a kind of short-chain fatty acid (SCFA), was decreased in EAP mice compared to that in controls, and supplementation with propionic acid reduced susceptibility to EAP and corrected the imbalance of Th17/Treg cell differentiation in vivo and in vitro . Furthermore, SCFA receptor G-protein-coupled receptor 43 and intracellular histone deacetylase 6 regulated by propionic acid in Th17 and Treg cells were also evaluated. Lastly, we observed that fecal transplantation from EAP mice induced the decrease of Treg cell frequency in recipient mice. Our data showed that gut dysbiosis contributed to a Th17/Treg differentiation imbalance in EAP via the decrease of metabolite propionic acid and provided valuable immunological groundwork for further intervention in immunologic derangement of CP/CPPS by targeting propionic acid.

目的 探讨精囊神经鞘瘤临床诊治特点.方法 分析1例精囊囊实性神经鞘瘤患者的临床诊疗经过,通过检索国内外相关文献进行总结分析.结果 患者经CT、MRI检查发现左侧精囊肿瘤,通过腹腔镜左侧精囊肿瘤切除术切除病灶,术后病理结果证实为神经鞘瘤,患者术后恢复良好,随访13月肿瘤无复发.结论 精囊神经鞘瘤临床罕见,首选腹腔镜手术治疗,能否保守治疗尚需大样本病例资料随访研究.

Background: The surgical treatment of horseshoe kidney (HSK) remains a huge challenge because of the complex anatomy and abnormal blood vessel distribution. Therefore, this study aimed to evaluate the surgical technique and outcomes of robot-assisted laparoscopic isthmus division using endoscopic transection equipment (endoscopic linear stapler; Ethicon, ECHELON 60 FLEX™) in the treatment of symptomatic HSK and to conduct a literature review. Materials and Methods: Patients with HSK who underwent robot-assisted laparoscopic isthmus division using endoscopic transection equipment from August 2015 to August 2019 at the First Affiliated Hospital of Anhui Medical University in China were recruited. Isthmus division was conducted using an endoscopic linear stapler. Results: All 10 surgeries were performed successfully. Major organs and large blood vessels were effectively protected. Only 1 patient presented with postoperative perinephric effusion. The mean operative time was 179 minutes, and the mean length of the postoperative hospital stay was 6 days. During the 1- to 5-year follow-up, all patients were cured with mitigated symptoms and improved renal function, except for 1 patient with transitional cell carcinoma who died of multiple metastases 18 months postoperatively. Conclusion: Robot-assisted laparoscopic isthmus division using endoscopic transection equipment is a safe and effective method to manage patients with symptomatic HSK and to help them have few complications and quick recovery. Clinical Trial Registration No: Quick-PJ 2021-03-18.

目的 探讨女性尿道憩室的临床诊断及治疗,提高对女性尿道憩室的认识.方法 回顾性分析安徽医科大学第一附属医院2020年1月—2021年6月收治的8例尿道憩室患者的病史特点、手术方法以及治疗效果.结果 除1例尿道憩室体检明确,其余7例患者均术前行四维盆底超声检查明确.8例尿道憩室患者均行经阴道前壁尿道憩室切除术.手术顺利,术后随访未见复发,无尿瘘、排尿不适等并发症.结论 盆底四维超声可以用于女性尿道憩室的辅助诊断.经阴道前壁尿道憩室切除术是主要治疗方法.