BACKGROUND:The gut microecosystem represents the most abundant and complex microbial ecosystem in the human body. Maintaining homeostasis of gut microbiota and their metabolites is essential for human health. As a chronic metabolic disorder, the association between benign prostatic hyperplasia (BPH) and gut microbiota remains unclear. Growing evidence suggests that modulating the composition and function of gut microbiota may influence the gut-prostate axis, thereby affecting the development and progression of prostatic hyperplasia. In this study, we employed network pharmacology to systematically elucidate the complex interactions among gut microbiota, microbial metabolites, and BPH-related therapeutic targets. METHODS:In this study, we first retrieved information on gut microbial metabolites from the gutMGene database. Subsequently, we identified overlapping targets of these metabolites using the SEA and STP databases. To further clarify targets related to BPH, we integrated data from authoritative databases such as Genecard and OMIM. Based on this information, we constructed a protein-protein interaction (PPI) network to screen for core targets. In addition, we performed systematic GO and KEGG functional enrichment analyses of these targets using the DAVID database. we constructed a network model to illustrate the interactions among microbiota, substrates, metabolites, and targets.Finally, molecular docking validation was performed between the core targets and gut microbiota metabolites. RESULTS:We identified 43 overlapping targets between gut microbial metabolites and BPH. Subsequently, we selected AKT1, IL-6, and IL-1B as core therapeutic targets for BPH. By constructing an MSMT comprehensive network, we found that these three core targets exert therapeutic effects on BPH through interactions with 11 metabolites, 2 substrates, and 4 gut microbial species. Furthermore, GO analysis revealed that gut microbial metabolites influence prostatic hyperplasia by regulating inflammation, immune responses, and the activation of oxidoreductase activity. KEGG analysis indicated that the AGE-RAGE signaling pathway, Toll-like receptor signaling pathway, HIF-1 signaling pathway, C-type lectin receptor signaling pathway, and PI3K/Akt signaling pathway are the major pathways involved in BPH.The molecular docking results demonstrated that butyrate may influence prostatic hyperplasia by modulating the AKT1 gene. DISCUSSION:This study employs a network pharmacology approach to elucidate the intricate "Microbiota-Substrate-Metabolite-Target" (M-S-M-T) network in Benign Prostatic Hyperplasia (BPH), identifying key hub genes (AKT1, IL-6, IL-1B), signaling pathways (PI3K/Akt, AGE-RAGE, HIF-1), and gut microbiota-derived metabolites (butyrate, propionate, TMAO) as central regulators. It further characterizes the functional significance of the Bifidobacterium-tryptophan and Clostridium sporogenes-tyrosine axes, highlighting their probiotic potential for microbiota-targeted BPH therapy. While demonstrating the therapeutic promise of modulating the gut microbiome, the study underscores the need for future experimental validation to decipher the precise mechanistic links within the M-S-M-T network and its role in BPH pathogenesis CONCLUSION: IL-6, AKT1, and IL-1B serve as the primary targets through which gut microbiota metabolites exert their therapeutic effects on benign prostatic hyperplasia.

Tumor recurrence and therapy resistance are frequently accompanied by alterations in cellular metabolism. However, how metabolic remodeling occurs and contributes to castration-resistant prostate cancer (CRPC) remains largely elusive. Here, we demonstrate that mitochondrial oxidative phosphorylation (OXPHOS) is critical for development of androgen receptor signaling inhibitors (ARSI) resistance. Our findings indicate that prostate cancer cells exhibit increased mitochondrial OXPHOS following ARSI treatment. Notably, there is no significant change in glycolytic activity. Importantly, this metabolic remodeling relies on glucose and glutamine utilization. Mechanistically, ARSI treatment activates reactive oxygen species/AMPK/SIRT1/PGC-1α signaling axis, leading to nuclear accumulation of PGC-1α and enhancement of mitochondrial OXHPOS and tricarboxylic acid cycle. High mitochondrial OXPHOS in turn renders prostate cancer cells resistant to ARSI. Inhibitors of PGC-1α and mitochondrial OXPHOS restore drug sensitivity and synergize with ARSI to inhibit CRPC growth. Our findings demonstrate the metabolic plasticity of prostate cancer cells following ARSI treatment, identifying PGC-1α/mitochondrial OXPHOS axis as a potential metabolic target for CRPC treatment.

Importance:Fumarate hydratase-deficient renal cell carcinoma (FH-deficient RCC) is a lethal kidney cancer that has limited therapeutic options. Objective:To evaluate the efficacy and safety of sintilimab plus axitinib for treatment of advanced FH-deficient RCC. Design, Setting, and Participants:This phase 2 multicenter, open-label, single-arm nonrandomized clinical trial enrolled patients with pathologically confirmed, treatment-naive, advanced FH-deficient RCC and an Eastern Cooperative Oncology Group Performance Status of 0 to 2 from July 1, 2021, to August 29, 2023, across 8 institutions in China. The data cutoff date was December 1, 2024. Intervention:Patients received sintilimab, 200 mg, intravenously every 3 weeks, combined with axitinib, 5 mg, orally twice daily, until disease progression, intolerable toxic effects, or withdrawal of consent. Main Outcomes and Measures:The primary end points were objective response rate (ORR) via Response Evaluation Criteria in Solid Tumors, version 1.1, and progression-free survival (PFS). Secondary end points included safety, overall survival, disease control rate (proportion of patients with complete or partial response or stable disease for ≥6 months), duration of response, and exploratory genomic-associated outcomes. Results:Of 52 patients screened for eligibility, 41 patients (median [range] age, 36 [18-75] years; 10 [24%] female) were enrolled. The median (range) duration of follow-up was 26.0 (0.7-41.6) months. Overall, ORR was 56% (23 patients; 95% CI, 40%-72%), with a median duration of response of not reached (NR; 95% CI, 23.3 months to NR). The disease control rate was 73% (30 patients). The median PFS was 19.8 months (95% CI, 10.9 months to NR). Patients with low somatic copy number alteration burden showed more favorable therapeutic outcomes. Thirteen patients (32%) experienced grade 3 or higher treatment-related adverse events, with the most frequent being hypertriglyceridemia in 3 (7%), rash in 2 (5%), and anemia in 2 (5%). Conclusions and Relevance:In this nonrandomized clinical trial, the combination of sintilimab and axitinib demonstrated encouraging ORR and PFS with manageable safety profile in patients with FH-deficient RCC. This combination therapy warrants further validation in a randomized clinical trial. Trial Registration:ClinicalTrials.gov Identifier: NCT04387500.

The imbalance between estrogen and androgen may be an important mechanism of BPH, but the specific mechanism remains unclear. We used mixed sustained-release pellets made of testosterone and estradiol (T + E2) to stimulate the establishment of a BPH rat model. Compared to the prostate hyperplasia rat model using only androgens, the new prostate hyperplasia rat model can be observed to have better macroscopic and pathological characteristics of prostate hyperplasia. We used RNA-seq and bioinformatics to detect differentially expressed genes (DEGs) between the prostate tissue of the novel benign prostatic hyperplasia rat group and the control group, including 458 DEGs, of which 336 were upregulated and 122 were downregulated. Then, RT-qPCR confirmed the authenticity of sequencing results. The analysis results showed that Kif4a and Mki67 were the top core genes in the PPI network. Moreover, we found that these two genes have a positive correlation with each other in multiple cancer tissues, normal tissues, and cancer cells. The DEGs were mainly involved in mitotic nuclear division, nuclear chromosome segregation, and cytokine cell receptor interactions. DEGs were also regulated by 250 miRNAs. In conclusion, we built a novel T + E2-induced rat BPH model, and discovered potentially important genes, pathways, and miRNA-mRNA regulatory networks.

Benign prostatic hyperplasia (BPH) is a common condition in middle-aged and elderly men. Disrupted circadian rhythms (CRD) can directly influence aging, inflammation, metabolic syndrome, and hormonal changes-all of which are closely linked to BPH. This study aimed to investigate whether CRD accelerates prostatic hyperplasia in rats. Twenty male Sprague-Dawley (SD) rats were divided into two batches. A BPH model was established using mixed slow-release pellets of testosterone (T) and estradiol (E2). CRD was induced by continuous light exposure (Cle), while a 12-hour light/12-hour dark cycle defined the control (Con) group. First batch:Rats were divided into T+E2 and T+E2+Cle groups. Initial and final body weight, prostate weight, and prostate index (PI) were recorded. Hematoxylin and eosin (H&E) staining was performed. Serum levels of dihydrotestosterone (DHT) and estradiol (E2) were measured by ELISA, and mRNA expression of circadian rhythm genes was assessed via qRT-PCR. Second batch:Rats were divided into Con and Cle groups. Body weight, prostate weight, and PI were recorded. H&E staining was used for pathological analysis. Ki-67 expression was assessed by immunohistochemistry (IHC). RNA sequencing (RNA-Seq) was used to investigate gene expression in prostate tissue, validated by qRT-PCR. Differentially expressed genes (DEGs) were analyzed using bioinformatics methods. First batch results:CRD significantly increased prostate weight, PI, and epithelial thickness; elevated serum DHT levels; and reduced E2 levels. qRT-PCR confirmed that CRD altered circadian gene expression. Second batch results:CRD significantly increased PI and Ki-67 expression in the prostate. GO analysis revealed significant enrichment in immune response, external side of plasma membrane, and carbohydrate binding (p < 0.001). Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis showed enrichment in cytokine-cytokine receptor interaction, viral protein interaction with cytokine and receptor, phenylalanine metabolism, and chemokine signaling pathways (p < 0.001). Gene set enrichment analysis (GSEA) indicated positive enrichment in voltage-gated calcium channel activity and type II diabetes mellitus. Protein-protein interaction (PPI) network analysis identified Itgad, Ccr7, CD27, Sell, CD69, Gzmb, IRF8, and KIrd1 as highly correlated genes. Conclusion:These findings suggest that CRD may accelerate prostate cell growth by modulating immune and inflammatory responses, contributing to the development of benign prostatic hyperplasia.

The conventional neoadjuvant chemotherapy regimen for locally advanced penile squamous cell carcinoma (La-PSCC) has shown moderate response rates and survival benefits. This single-arm, phase II trial (NCT04475016) evaluated a neoadjuvant regimen of four cycles of toripalimab (anti-PD-1 antibody), nimotuzumab (anti-EGFR antibody), and taxol-based chemotherapy (TNT), followed by consolidative surgery. The primary endpoint was the pathological complete response (pCR) rate. Among 29 enrolled patients, 24 (82.8%) underwent consolidative surgery, with 14 (48.3%, 95% confidence interval [CI], 29.4-67.5%) achieving pCR. The objective response rate (ORR) was 82.8% (95% CI, 64.2-94.2). Median follow-up was 39.97 months, with two-year overall survival (OS) and progression-free survival (PFS) rates of 72.4% and 65.5%. Grade 3-4 treatment-related adverse events (TRAEs) occurred in 12 (41.4%) patients, with no treatment-related deaths. Biomarker analysis identified PD-L1 expression, TP53 mutation status, and CD8+ T cell density as potential predictive markers. Therefore, neoadjuvant TNT shows promising anti-tumor activity and acceptable toxicity.

Renal tuberculosis is one of the main reasons for nephrectomy. Early removal of tuberculous lesions can preserve the remaining functional renal tissue and help avoid nephrectomy. Robotic-assisted surgery significantly improves the success rate of partial nephrectomy. The present study aims to introduce a modified robotic surgical approach, the 'unroofing and base excision' technique, for treating localized renal tuberculosis. Four patients with localized renal tuberculosis underwent our modified robot-assisted laparoscopic partial nephrectomy. In traditional approaches, lesions were excised at least 0.5 cm from the margin, and the lesion cavity was left intact. In the current procedure, surgery begins with opening the lesion cavity, and the cavity wall is then lifted to identify the boundary between the lesions and the surrounding normal tissue, allowing excision of the lesions approximately 0.2 cm from the cavity wall. The lesion base is removed from the interior to the exterior of the cavity. The operative times were 130, 120, 145, and 160 minutes, with corresponding warm ischemia times of 27, 25, 35, and 45 minutes. The abdominal drainage tube remained in place for 8, 7, 9, and 5 days, respectively. None of the patients experienced postoperative urine leakage, bleeding, or intraperitoneal infection. The median follow-up was 23.5 months. The preoperative serum creatinine levels were 45, 88, 130, and 55 µmol/L, which changed to 57, 83, 161, and 64 µmol/L at the last follow-up visit. The preoperative glomerular filtration rates of the affected kidneys were 28.3, 20.2, 28.1, and 29.6 mL/min, which declined to 20.5, 16.6, 26.6, and 24.9 mL/min at the last follow-up visit. Radiological imaging showed that the remaining renal tissue on the affected side retained normal morphology and structure at the last follow-up visit. Overall, our 'unroofing and base excision' technique enables the complete removal of tuberculous lesions while maximizing the preservation of functional renal tissue.

Background Prostatic fibrosis, characterized by the accumulation of myofibroblasts and collagen deposition, is closely associated with LUTS and may lead to mechanical obstruction of the urethra. Additionally, Metabolic Syndrome (MetS), characterized by central obesity, high blood sugar, lipid metabolism disorders, and hypertension, is increasingly recognized as a proinflammatory condition linked to prostate inflammation. Methods Clinical data from 108 subjects who underwent transurethral resection of the prostate or bipolar plasmakinetic enucleation of the prostate were prospectively collected between June 2021 and August 2022. Patients were divided in two groups according to whether or not they had a diagnosis of MetS. Specimens were stained with Masson trichrome and the periurethral prostatic fibrosis extent was evaluated using quantitative morphometry. Results Forty-three patients (39.8%) were diagnosed with MetS. Patients with MetS showed a significantly greater extent of prostatic fibrosis than the others (68.1 ± 17.1% vs. 42.5 ± 18.2%, P < 0.001), and there was a positive correlation between the number of positive MetS parameters and the extent of prostatic fibrosis ( R 2 = 0.4436, P < 0.001). Multivariate regression analysis revealed that central obesity (B = 2.941, 95% confidence interval, 1.700–3.283), elevated fasting glucose (B = 1.036, 95% confidence interval, 0.293–1.780), reduced HDL cholesterol (B = 0.910, 95% confidence interval, 0.183–1.636) and elevated triglycerides (B = 1.666, 95% confidence interval, 0.824–2.508) were positively correlated to prostatic fibrosis. Elevated blood pressure, however, was unrelated to prostatic fibrosis (B = 0.009, 95% confidence interval, -0.664–0.683). Conclusions The present findings suggest that prostatic fibrosis is positively correlated with MetS and its components including central obesity, elevated fasting glucose, reduced high density lipoprotein cholesterol and elevated triglycerides.

The current study aimed to investigate the feasibility and safety of robot-assisted laparoscopic resection of the isthmus in patients with symptomatic horseshoe kidney. A retrospective analysis of clinical data from four patients with symptomatic horseshoe kidney treated between January 1, 2021 and December 31, 2023 at Guizhou Provincial People's Hospital was conducted. The main surgical procedures included robot-assisted laparoscopic resection of the isthmus, kidney fixation, pyeloplasty, and pyelolithotomy. All four patients underwent successful surgery. One patient had concomitant calculi. The mean operative time was 179.8 minutes, with an average blood loss of 49.5 ml. In patients followed up for 3 months, 6 months, 1 year, and 2 years postoperatively, renal anatomy remained normal, significant improvement in hydronephrosis was observed compared to preoperative status, serum creatinine levels returned (maintained) to normal status, and no surgery-related complications occurred during the perioperative period. This study reports the safety and feasibility of robot-assisted laparoscopic resection of the isthmus in patients with symptomatic horseshoe kidney. This surgical approach effectively restores the abnormal anatomical structure of the horseshoe kidney, reestablishes the natural course of the ureter, and prevents compression of the ureter by the isthmus of the horseshoe kidney.

This study aimed to investigate the effects of sex hormone imbalance on rat prostatic inflammation and fibrosis and identify the key molecules involved. Castrated Sprague–Dawley (SD) rats were treated with a constant dose of oestradiol (E2) and different doses of dihydrotestosterone (DHT) to achieve different oestrogen/androgen ratios. After 8 weeks, serum E2 and DHT concentrations, relative seminal vesicle weights, histopathological changes and inflammation were measured, collagen fiber content and oestrogen receptor (ER) and androgen receptor (AR) expression were detected, mRNA sequencing and bioinformatics analysis were performed to identify differentially expressed genes (DEGs). The severity of inflammation in the rat dorsolateral prostate (DLP) was higher, collagen fibre content and ER expression in the rat DLP and prostatic urethra were increased and AR expression in the rat DLP was decreased in the 1:1 E2/DHT-treated group than that in the 1:10 E2/DHT-treated group. RNA-seq analysis identified 487 DEGs, and striking increases in the expression of mRNAs encoding collagen, collagen synthesis and degradation enzymes, growth factors and binding proteins, cytokines and chemokines, and cell-surface molecules were confirmed in the 1:1 E2/DHT-treated group compared to the 1:10 E2/DHT-treated group. mRNA expression of secreted phosphoprotein 1 (Spp1) and protein expression of osteopontin (OPN, encoded by Spp1) were increased in the 1:1 E2/DHT-treated group compared to the 1:10 E2/DHT-treated group, and Spp1 expression correlated positively with Mmp7, Cxcl6 and Igfn1 expression. The imbalance in the oestrogen/androgen ratio may affect rat prostatic inflammation and fibrosis, and OPN might be involved in this process.

近年来,前列腺癌的发病率及致死率在国内外不断增加,前列腺癌的早期诊断对其治疗、预后等尤为重要.目前,MRI,尤其是多参数MRI已被国际组织强烈推荐用于前列腺癌的诊断.随着人工智能的发展,MRI联合人工智能技术极大的推动和实现了前列腺癌的早期精准诊断,很大程度上降低了漏诊率和误诊率,避免了过度医疗.因此,本文就近年来国内外MRI联合人工智能在前列腺癌诊断中的应用以及相关局限性等方面展开综述,以期为未来相关的临床应用与研究提供参考依据.

Catheter-related bladder discomfort (CRBD) is a common postoperative bladder pain syndrome. Many drugs and interventions for managing CRBD have been studied, but their comparative effectiveness remains controversial. We made a study to assess the comparative effectiveness of interventions included Ketorolac, Lidocaine, Chlorpheniramine, Gabapentin, Magnesium, Nefopam, Oxycodone, Parecoxib, Solifenacin, Tolterodine, Bupivancaine, Dexmedetomidine, Hyoscine N-butyl bromide, Ketamine, Penile nerve block on urological postoperative CRBD. We performed a network meta-analysis via Aggregate Data Drug Inormation System software included 18 studies with 1816 patients and assessed the risk of bias by Cochrane Collaboration tool. The incidence of moderate to severe CRBD at 0, 1, and 6 h after surgery and the incidence severe CRBD at 1 h after surgery were compared. The number of best rank is 0.48(Nefopam) and 0.22(Nefopam) in the incidence of moderate to severe CRBD at 1 h and incidence severe CRBD at 1 h. More than half of studies at unclear or high risk of bias. Nefopam reduced the incidence of CRBD and prevented severe events, but limited by the small number of studies for each intervention and heterogeneous patients.

Abstract BACKGROUND: The golden standard for the treatment of muscle-invasive or high-grade bladder cancer is radical cystectomy combined with various forms of urinary diversion, but postoperative paralytic ileus is an troublesome postoperative complication.The purpose of this research is to build and verify the nomogram prediction model of postoperative ileus.METHODS: From January 2015 to December 2020, the clinical data of patients who underwent radical cystectomy in the urology department of Guizhou Provincial People's Hospital for bladder cancer were collected. The risk factors related to postoperative ileus were obtained by logitic single factor and multiple factor regression analysis. Then, the prediction model of postoperative ileus was constructed based on the risk factors and its identification ability and accuracy were verified.RESULT: 252 patients were included, 51 of whom had ileus. Statistical analysis showed that preoperative creatinine level, postoperative creatinine level, and postoperative serum albumin concentration were correlated with postoperative ileus. The area under ROC curve of nomogram predictive model constructed based on the risk factors was 0.748 (95%CI 0.672-0.824). The bootstrap correction curve of the prediction model shows that the prediction accuracy of the model is close to that of the ideal model.CONCLUSION: Preoperative creatinine level, postoperative creatinine level, and postoperative serum albumin concentration were correlated with postoperative ileus and were risk factors for ileus after radical cystectomy, which could be used as predictors of clinical prediction models. The prediction model of nomogram based on these predictors can predict the probability of postoperative intestinal obstruction.

Objectives: To examine the disparities between COVID-19 studies conducted in high-income countries (HICs) and low-and middle-income countries (LMICs). Methods: We used the International Clinical Trials Registry Platform to identify COVID-19-related studies registered from December 31, 2019 to December 31, 2021. The World Bank definition was used to clas-sify countries as high-, upper-middle-, lower-middle-, and low-income. The last three were considered to be LMICs. We examined the disparities in response speed, classification of medicines and vaccines, and registration and results reporting compliance between COVID-19 studies conducted in HICs and LMICs. Results: We included 12,396 COVID-19 studies, with 6631 (53.5%) from HICs. HIC-registered studies reached a peak of 1039 in April 2020, whereas LMICs had only 440 studies. Of the 6969 interventional trials, those from HICs showed higher registration compliance (2199, 62.3% vs 1979, 57.6%, P < 0.001) and results reporting compliance (hazard ratio 0.39, 95% confidence interval 0.28-0.55, P < 0.001) than LMICs. HICs also conducted significantly more small-molecule drug (956, 57.5% vs 868, 41.2%, P < 0.001) and messenger RNA vaccine trials (135, 32.9% vs 19, 4.8%, P < 0.001) than LMICs. Conclusion: HICs conducted COVID-19 trials with faster response speed and higher registration and publi-cation compliance and produced more innovative pharmaceutical and vaccine products to combat COVID-19 than LMICs. (c) 2023 The Author(s). Published by Elsevier Ltd on behalf of International Society for Infectious Diseases. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

机器人辅助腹腔镜肾盂成形术(RALP)从首次报道到现在已有20年,它已成为国内外治疗肾盂输尿管连接部梗阻的主要术式.机器人手术系统的更新迭代、外科手术技术的不断进步、护理理念的改变等全面提升了肾盂输尿连接部梗阻治疗的质量.相比较传统的开放及腹腔镜手术,机器人辅助腹腔镜肾盂成形术在保持90％以上成功率的同时,明显降低了手术并发症并缩短了恢复期,已成为传统金标准的又一挑战.本共识主要聚焦RALP的适应证、常用手术方式及围手术期注意事项.

Objective:To summarize and analyze the current application status of oral mucosal graft (OMG) technique in the repair of ureteral strictures in China, and clarify the feasibility, safety and effectiveness of this technique.Methods:The 175 patients who underwent repair of ureteral stricture using oral mucosal patches from June 2015 to February 2022 were etrospectively analyzed in 14 medical centers in China, including 49 cases in Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 32 cases in Affiliated Seventh Medical Center of PLA General Hospital, 3 cases in The Second Hospital of Anhui Medical University, 6 cases in The First Affiliated Hospital of Zhengzhou University, 56 cases in Peking University First Hospital, 3 cases in Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 cases in Shanghai Sixth People' s Hospital, 4 cases in General Hospital of Estern Theater Command, 4 cases in Lanzhou University Second Hospital, 2 cases in Guizhou Province People 's Hospital, 2 cases in Peking University People' s Hospital, 5 cases in Jinzhou First People's Hospital, 5 cases in The First Affiliated Hospital of Wannan Medical College, 1 case in Shandong Provincial Hospital. In this study, 127 patients (72.6%) used lingual mucosal patches, 32(18.3%) labial mucosa, and 16(9.1%) buccal mucosa. The surgical approach for OMG ureteral reconstruction was mainly minimally invasive, with robot-assisted laparoscopy in 84 patients (48.0%), traditional laparoscopic surgery in 87 patients (49.7%), and open surgery in only 4 patients (2.3%). There were 133 males and 42 females with an average age of (35.0±17.2) years. The mean body mass index (BMI) and stenosis length were (23.1±4.1) kg/m 2 and (4.7±1.8) cm, respectively. The stricture was located in the left ureter in 116 patients, right ureter in 58 case and bilateral ureter in 1 case. The most common causes of ureteral stricture were endoscopic surgery in 88(50.3%)patients, congenital stricture in 55(31.4%)patients, failed ureteroplasty in 29(16.6%)patients, history of extracorporeal shock wave lithotripsy in 13(7.4%)patients, radiotherapy history in 3(1.7%)patients and other causes in 6(3.4%)patients. Strictures were mainly located in the upper ureter, accounting for 61.7% (108/175 cases), followed by 36.0% (63/175) at the ureteropelvic junction and 2.3%(4/175)in the middle ureter. According to the surgical methods, the patients were divided into robot-assisted laparoscopic surgery group ( n=84), traditional laparoscopic surgery group ( n=87)and open surgery group ( n=4). Subgroup analysis of patients in robot-assisted laparoscopic and traditional laparoscopic surgery groups was performed. There were no significant difference in preoperative data between the two groups except for age (32.0±18.3) years vs.(37.0±15.9)years, P=0.040], BMI[(22.5±4.3)kg/m 2 vs. (23.7±3.6)kg/m 2, P=0.028], and etiology of stenosis [endoscopic injury, 34(40.5%) vs. 53(60.9%), P=0.012]. Preoperative hydronephrosis and stricture length were assessed by CTU and ureterography. Ureterography 7-9 weeks after surgery showed patency of the reconstructed segment, or no recurrence of hydronephrosis was judged as success. Evaluate the operation method, operation time, success rate, length of OMG in repairing ureteral stricture between laparoscopic and robot-assisted groups. Results:The overall success rate of oral mucosal graft repair surgery reached 97.7%(171/175). The success rate of ureteral reconstruction in the two groups were 96.4%(81/84)and 98.9%(86/87), respectively ( P=0.351), and the difference was not statistically significant. There was no significant difference for operation time, intraoperative blood loss, and mean oral mucosal length between the robotic and laparoscopic groups[(244.7±85.8) min and (222.7±83.5)min ( P=0.116), (58.9±38.6) ml and (68.4±45.5) ml ( P=0.217), (5.0±2.0) cm and (4.6±1.5) cm ( P=0.350)], respectively.Postoperative complications were reported in 23 (13.1%) patients, such as fever, urinary leakage, lymphatic leakage, infection, but only 2 (1.4%) cases patients had complications of Clavien-Dindo score ≥ Ⅲ. The two patients developed urinary stricture after surgery with failed conservative treatment, and no urinary stricture occurred following endoscopic treatment.The short-term (three months after surgery)incidence of complications in the site where the oral mucosa was taken, such as difficulty in opening mouth, pain, and swelling, was 12.0% (21/175), and there was no significant difference for oral complications between patients harvesting different length of mucosal graft. Conclusions:Ureteroplasty with oral mucosal graft is a safe, feasible and reliable technique for ureteral reconstruction. At present, minimally invasive technology is the main surgical approach for ureteroplasty, and there is no significant difference in operation time and success rate between robotic surgery and laparoscopic surgery.

Ureteral calculi after lingual mucosal ureteral reconstruction are rare. In this paper, we reported a case of a male patient who had undergone robotic-assisted laparoscopic lingual mucosal right ureteroplasty. Calculi were found in the right reconstructed ureteral segment 4 months after surgery. Then the patient underwent transurethral ureteroscopic holmium laser lithotripsy combined with a stone retrieval basket, and postoperative urological CT showed no residual calculi in the right ureter. No recurrence of right ureteral calculi or complications were observed during 20 months of follow-up.

In ageing men, benign prostatic hyperplasia (BPH) is a chronic disease that leads to progressive lower urinary tract symptoms (LUTS) caused by obstruction of the bladder outlet (BOO). Patients with LUTS (such as increased frequency and urgency of urination) and complications of BOO (such as hydronephrosis and bladder stones) are at risk of serious health problems. BPH causes a rapidly rising burden of LUTS far exceeding that of other urological conditions. Treatment outcomes are unsatisfactory for BPH largely due to the lacking of fully understanding of the pathogenesis. Hormonal imbalances related to androgen and oestrogen can cause BPH, but the exact mechanism is still unknown, even the animal model is not fully understood. Additionally, there are no large-scale data to explain this mechanism. A BPH mouse model was established using mixed slow-release pellets of testosterone (T) and estradiol (E2), and we measured gene expression in mouse prostate tissue using RNA-seq, verified the results using qRT‒PCR, and used bioinformatics methods to analyse the differentially expressed genes (DEGs).

Objective:To construct a C57BL/6 mouse model of simulating transurethral thulium laser vaporization prostatectomy.Methods:Twelve male C57BL/6 mice were selected to undergo transvesical vaporization resection of the urothelium covering the urethra of the prostate using thulium laser. The urethral tissue of the prostate was retrieved on the 1st, 3rd, 5th, and 7th days after the surgery. HE staining was used to observe the process of re-epithelialization of the urethral wound of the prostate. Immunohistochemical (IHC) staining was used to detect whether the re-epithelialized cells of the urethral wound of the prostate expressed urothelin Ⅲ (UPⅢ).Results:On the first day after surgery, HE staining showed complete destruction to the urothelium covering the urethra of the prostate, with a large amount of coagulative necrotic tissue on the wound surface, and IHC staining showed no expression of UPⅢ on the wound surface. On the 3rd day after surgery, HE staining showed that there were still no regenerated epithelial cells on the wound surface, with coagulation necrosis tissue significantly reduced, and the urethral cavity was clearly visible. And IHC staining showed no expression of UPⅢ on the wound surface. On the 5th day after surgery, HE staining showed 1-2 layers of regenerated epithelial cells lacking cell polarity on the wound surface, and IHC staining showed that the regenerated epithelial cells expressed UPⅢ. On the 7th day after surgery, HE staining showed 4-6 layers of polar regenerated epithelial cells on the wound surface, and IHC staining showed the multiple layers of regenerated epithelial cells expressing UPⅢ.Conclusions:Based on the simulation of transurethral thulium laser vaporization resection of the prostate, the thulium laser and ultra micro endoscope system were used to vaporize the urothelium covering the urethra of the prostate, and the process of urethral re-epithelialization of the prostate can be observed after surgery. The establishment of the C57BL/6 mouse model simulating thulium laser vaporization prostatectomy provides a new research platform for studying the mechanism of wound repair after prostatectomy.