Intraoperative blood loss (IBL) is a critical precipitating factor of intraoperative and postoperative complications. This study aims to identify risk factors and employ machine learning (ML) techniques to develop models for predicting IBL in patients undergo retroperitoneal laparoscopic adrenalectomy (RLA). A retrospective study was performed with data from patients who underwent unilateral RLA at Beijing Anzhen Hospital from 2014 to 2021. The data were randomly divided into training and validation sets. A volume ≥ 100 ml was defined as high IBL. Model training incorporated feature selection with least absolute shrinkage and selection operator (LASSO) and algorithms including logistic regression (LR), random forest (RF), neural network (NN), K-nearest neighbor (KNN), support vector machine (SVM) and AdaBoost. Various indicators were utilized to evaluate model performance. A total of 530 RLA cases were included. LASSO regression identified gender, surgeons’ experience, disease type, lesion diameter and lesion location as predictive factors. Six ML models were derived and evaluated. Among which, LR, RF and NN models exhibited exceptional discriminatory power. The area under the curve (AUC) of the three models were 0.775, 0.769, 0.729 in the validation set, respectively. A nomogram and a online calculator were created. The calibration curve, decision curve analysis and clinical impact curve revealed its excellent clinical utility. This study presented and compared the use of various ML models for predicting IBL in RLA, which could assist in assessing surgical risks and tailored treatments without additional examination, and providing insights for the clinical application of ML.

Background: There is inconsistent evidence regarding obesity's effect on surgical outcomes following retroperitoneal laparoscopic adrenalectomy (RLA). This study aimed to investigate the influence of obesity on surgical outcomes in patients undergoing RLA, with an emphasis on operative time, drainage tube removal time, postoperative hospital stays and perioperative complications. Methods: In this retrospective, single-center, observational study, all consecutive cases of unilateral RLA for adrenal disease from January 2012 to December 2021 were incorporated. The patients were divided into two groups based on their body mass index (BMI) of 28 kg/m 2 . To mitigate selection bias, propensity score matching (PSM) was conducted, using logistic regression to calculate propensity scores for balancing baseline characteristics. A multivariate logistic regression analysis was performed to assess how obesity affects operative time and intraoperative blood loss as well. The linear correlation between BMI and surgical outcomes, including prolonged operative time and increased intraoperative blood loss, was also examined using restricted cubic spline (RCS) analysis. Results: A total of 569 patients who underwent RLA were included. After PSM, 122 patients were apportioned to each group. Statistically significant differences were observed between the obese and nonobese group in operative time (97.5 vs. 115 min, P<0.001). There were no statistically significant differences between the two groups regarding hospital stay (6.7 vs. 6.8 days, P=0.58), drainage tube removal time (3.0 vs. 3.0 days, P=0.19), nor postoperative complications (9.0% vs. 12.3%, P=0.41). Furthermore, univariate logistic regression analysis revealed that, obese patients undergoing RLA were linked to prolonged operative time and increased intraoperative blood loss. After adjusting for potential confounders, the obese group showed a 67% increased risk of prolonged operative time and a 69% increased intraoperative blood loss. The RCS analysis revealed that BMI had a linear relationship with operative time (P for nonlinearity =0.47) and blood loss during surgery (P for linearity =0.89). Conclusions: In patients undergoing RLA, obesity exerts a significant influence on surgical outcomes, particularly with regard to operative time and intraoperative blood loss, as shown in multivariable logistic regression analysis and PSM to balance baseline characteristics.

Objective:To explore the risk factors of prolonged operation time and higher intraoperative blood loss of retroperitoneal laparoscopic radical nephrectomy (LRN).Methods:The data of patients who underwent retroperitoneal LRN from August 2010 to December 2021 were analyzed retrospectively. Demographic and hospital admission data were collected from these patients with complete medical records. Furthermore, univariate and multivariate logistic analysis were performed to determine the risk factor related to prolonged operation time and increased blood lose following LRN. Receiver operating characteristic (ROC) curve was used to assess the value of risk factors for predicting prolonged operation time and high intraoperative blood loss.Results:A total of 22 patients (24.4%) had prolonged operation time, and 14 patients (15.6%) had high intraoperative blood loss. The risk factor associated with prolonged operation time in a multivariate analysis was surgical experience (OR=0.13, P<0.001). The area under the ROC curve was 0.759 (95% confidence interval: 0.638-0.880) in the multivariate logistic regression model for predict prolonged operation time. Those associated with high intraoperative blood loss were surgical experience (OR=0.25, P=0.032) and tumor T stage (OR=3.18, P=0.007). The area under the ROC curve was 0.769 (95% confidence interval: 0.627-0.910) in the multivariate logistic regression model for predict high intraoperative blood loss.Conclusions:Surgical experience and tumor T stage were associated with the risk of prolonged operation time and high intraoperative blood loss.

Background: While laparoscopic adrenalectomy (LA) represents a gold standard for treating most adrenal lesions, no effective visual model for the prediction of perioperative complications of retroperitoneal laparoscopic adrenalectomy (RLA) exists.Methods: A retrospectively study was conducted involving all consecutive patients underwent unilateral RLA for adrenal disease from January 2012 to December 2021. The entire cohort was randomly divided into 2 subsets (70% of the data for training, 30% for validation). Subsequently, a Least Absolute Shrinkage Selection Operator (LASSO) regression was performed to select the predictor variables, which were further consolidated via random forest (RF) and Boruta algorithm. Then the nomogram was established using the bivariate logistic regression analysis. Eventually, the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) were employed to evaluate discrimination, calibration and clinical usefulness of the model, respectively.Results: A total of 610 patients underwent unilateral RLA for adrenal diseases were enrolled. After machine learning analyses, a weighted nomogram was established with 7 factors associated with complications including operative time, lesion laterality, intraoperative blood loss, pheochromocytoma, body mass index (BMI) and 2 preoperative comorbidities (respiratory diseases, cardiovascular diseases (CVD)). The model displayed a fine calibration curve for perioperative complications evaluation in both the training dataset (P=0.847) and validation dataset (P=0.248). ROC with AUC revealed an excellent discrimination in the training dataset (0.817, 95% CI: 0.758-0.875) and validation dataset (0.794, 95% CI: 0.686-0.901). DCA curves showed that using this nomogram provided a more net benefit where threshold probabilities lay in the range of 0.1 to 0.9.Conclusions: An effective nomogram that incorporating 7 predictors was established in this study to identify patients at high risk of perioperative complications for RLA. It would contribute to the improvement of perioperative strategy due to its accuracy and convenience.

目的 探讨经腹膜后入路腹腔镜肾上腺切除术(RLA)手术时间延长的危险因素.方法 回顾性分析2016年1月-2021年12月该院泌尿外科收治的420例因肾上腺病变行RLA手术的患者的临床资料,包括:年龄、性别、体重指数(BMI)、合并症、既往腹部手术史、手术时间、瘤体大小、术后病理类型和肿瘤位置等.以手术时间的第75百分位数(140 min)为分界点,手术时间超过140 min的,定义为手术时间延长.分别应用单因素和多因素Logistic回归模型,分析引起RLA手术时间延长的危险因素,计算受试者操作特征曲线(ROC curve)的曲线下面积(AUC),分析相关因素对RLA手术时间延长的预测价值.结果96例(22.86%)出现手术时间延长.单因素Logistic回归分析结果显示,男性、BMI≥31 kg/m2、术者经验(≤30例)、手术方式(肾上腺全切)、瘤体直径≥3.6 cm、病理类型(肾上腺皮质增生和嗜铬细胞瘤),与RLA手术时间延长有关.多因素Logistic回归分析结果显示,男性、BMI≥31 kg/m2、术者经验(≤30例)、瘤体直径≥3.6 cm和嗜铬细胞瘤,是引起RLA手术时间延长的独立危险因素.以病理类型(嗜铬细胞瘤)、性别(男性)、术者经验(≤30 例)、BMI≥31 kg/m2 和瘤体直径≥3.6 cm为预测因素,AUC为 0.735(95%CI:0.678～0.793).结论 RLA手术时间延长与性别、BMI、病理类型、术者经验和瘤体直径等因素有关,术前对这些危险因素进行识别,有助于更准确地选择手术方案,缩短手术时间.

Objective:To analyze the side effects and complications in prostate cancer patients treated with brachytherapy.Methods:A total of 120 prostate cancer patients with average age of (73±5) years were recruited. All the patients were diagnosed as prostate cancer and accepted prostate brachytherapy from 2011 to 2019 under the guidance of transrectal ultrasound. The adverse reactions of urinary tract and their complications after prostate cancer 125I seed implantation were analyzed retrospectively.Results:A total of 120 patients with prostate cancer were collected and the clinical average Gleason score was (8.4±1.1). The IPSS scores of the patients were (13.1±3.6), (21.6±4.6), (19.2±4.4), (15.9±3.9), (13.9±3.1) and (13.5±2.7) before operation, 1 month after operation, 3 months after operation, half a year after operation, 1 year after operation and 2 years after operation, respectively. The incidence of grade I and grade II complications was 14.2% and 5.8% respectively within 1 month after operation, and 5.0% and 2.5% respectively within 3 months after operation. There were no grade III or IV complications.Conclusions:Prostate brachytherapy is a minimally invasive treatment for prostate cancer. Although the implantation of particles has a certain impact on the urination of patients, but the degree is relatively light, with a certain degree of self-limiting. Intraoperative accurate localization and making accurate implantation plan are factors to the prevention of serious complications.

Objective:To explore the risk factors associated with postoperative complications and prolonged length of stay (LOS) following retroperitoneal laparoscopic radical nephrectomy (LRN).Methods:A retrospective data gathering from 103 patients in Beijing Anzhen hospital who underwent retroperitoneal LRN from Aug. 2010 to Aug. 2021 was conducted. The demographic and clinical data of the patients, including age, gender, Body Mass Index (BMI), comorbidities, American Society of Anesthesiologists (ASA) score, previous abdominal surgery, tumor size, T stage, intraoperative blood loss, intraoperative blood transfusions, postoperative complications and postoperative length of stay, were retrospectively collected. We examined the overall postoperative complications, which were categorized using the Dindo-Clavien classification system. A prolonged LOS was quantified in terms of postoperative hospital stay >10 days, which was defined as LOS >75th percentile of the dataset. Furthermore, univariate and multivariate logistic analysis were performed to identify the risk factor related to postoperative Clavien-Dindo complications and prolonged LOS.Results:Overall, 103 participants participated in the study. A total of 16 cases (15.5%) suffered postoperative complications of Clavien-Dindo classification grade of 2 or more, and 17 cases (16.5%) had prolonged LOS. The risk factors associated with an increased prevalence of postoperative complications in a multivariate analysis were: operation time ≥240 minutes (OR: 5.17, P=0.024) and intraoperative blood loss >300 ml (OR: 22.89, P=0.001). Those associated with an increased prevalence of prolonged LOS was intraoperative blood transfusion (OR: 9.94, P=0.023).Conclusions:Postoperative complications and prolonged LOS following LRN were related to intraoperative blood loss, operative time, and intraoperative blood transfusion.

Background To evaluate whether the overexpression of chemokine receptor-7 (CXCR7) in prostatic tissues obtained from men with Castration-Resistant Prostate Cancer (CRPC) is associated with resistance to enzalutamide (Enza). Methods Based on the inclusion criteria of CRPC in EAU guidelines, all eligible patients treated in our hospital from January 2015 to December 2019 were included. Cases underwent radical prostatectomy, docetaxel-based chemotherapy, or new endocrine therapies (including Enza or abiraterone), and cases with severe cardiopulmonary disease or other malignant tumors were excluded. After immunohistochemical staining for CXCR7 expression in prostatic biopsy tissues, all enrolled cases were divided into two groups, namely, the CXCR7-positive group and the CXCR7-negative group. And then, PSA response to Enza treatment was recorded in detail and comparatively analyzed. In addition, the Cox proportional hazard modeling and the Kaplan-Meier analysis were used to determine PSA progression-free survival (PSAP-FS) and clinical or radiographic progression-free survival (CRP-FS) in this cohort. Results A total of 79 CRPC individuals were enrolled and evaluated in this study. Median follow-up durations were 24 months (range, 12-42) in the CXCR7-positive group (n = 47) and 28.5 months (range, 12-42) in the CXCR7-negative group (n = 32). The patients with lower CXCR7 expression showed much better PSA response to Enza treatment. There was 84.4% of CXCR7- cases showing decreasing PSA response, while there were 71.4% in the CXCR7/1+ group and 31.2% in the CXCR7/2+ group, respectively. All patients in the CXCR7/3+ group showed increasing PSA response to Enza treatment. And the percentage of patients whose PSA decreased over 50% is significantly higher in the CXCR7-negative group than in the CXCR7-positive group (68.8% vs. 8.5%, P < 0.001), and the percentage of patients whose PSA decreased over 90% is also remarkably higher in the CXCR7-negative group (43.8% vs. 0, P < 0.001). The Kaplan-Meier analysis demonstrated that the oncologic outcomes of CXCR7-negative patients were improved much significantly by Enza treatment in comparison with those of CXCR7-positive patients. Significantly increased median PSAP-FS (21 months vs. 6 months, P < 0.0001) and CRP-FS (27 months vs. 9 months, P < 0.0001) were obtained in the CXCR7-negative group. The further stratified analysis in all CXCR7-positive patients demonstrated that the patients with higher CXCR7 expression showed much worse outcome. The median time of PSAP-FS was 21 months in the CXCR7/1+ group, 9 months in the CXCR7/2+ group, and 6 months in the CXCR7/3+ group, while the median time of CRP-FS was 21 months in the CXCR7/1+ group, 12 months in the CXCR7/2+ group, and 6 months in the CXCR7/3+ group, respectively. Conclusion Overexpression of CXCR7 induced by an AR antagonist in CRPC patients displays much better treatment response to Enza. CXCR7 might be a novel therapeutic target gene for CRPC patients.

This prospective randomized comparative trial study aimed to evaluate the therapeutic outcomes of radical nephroureterectomy and adjuvant chemotherapy (ACT) used in combination in high risk upper tract urothelial carcinoma (UTUC) patients with cardiovascular comorbidity. Based on the inclusion criteria of high-risk UTUC in EAU guidelines (updated in 2014), all eligible patients treated in our hospital from January 2014 to March 2018 were included, and cases with late disease, renal dysfunction, severe cardiopulmonary disease or other malignant tumors were excluded. The cases were randomized into two groups based on treatment regimen. Multivariate analyses were performed to analyze the influencing factors of survival outcome in the enrolled patients. The Cox proportional-hazards model and the Kaplan–Meier method were employed to assess progression free survival (PFS), overall survival (OS) and cancer specific survival (CSS). In addition, the potential adverse effects of chemotherapy were actively monitored. A total of 176 high-risk UTUC individuals with cardiovascular comorbidity were enrolled and evaluated in this study. Median follow-up durations were 30 months (range 6–54) in the RNU (n = 82) group and 36 months (range 6–54) in the RNU + ACT (n = 94) group. Multivariable analysis indicated that peri-operative cardiovascular events risk grade was independent prognostic factor for OS. Tumor size was independent prognostic factor for PFS and CSS. BMI and lymphovacular invasion were significant predictors of PFS. Clinical stage, lymph node involvement, and tumor grade were significant predictors of PFS, OS and CSS in these patients. Especially, chemotherapy was helpful in improving PFS [ P < 0.001, HR = 6.327 (5.115–7.793)], OS [ P = 0.013, HR = 2.336 (1.956–2.883)] and CSS [ P = 0.008, HR = 3.073 (2.533–3.738)]. Kaplan–Meier analysis demonstrated that the oncologic outcomes of RNU treated high-risk UTUC patients were improved much significantly by ACT, including PFS [ P = 0.0033, HR = 3.78 (3.13–4.55)], OS [ P = 0.0397, HR = 1.39 (1.01–1.75)] and CSS [ P = 0.0255, HR = 1.26 (1.07–1.45)]. Further analysis of the lymph node positive subgroup showed that the median time of oncologic events was enhanced in RNU + ACT treated individuals in comparison with the RNU group, including PFS (11.4 months vs. 31.9 months, P = 0.0018), OS (26.8 months vs. 36.3 months, P = 0.0255) and CSS (28.2 months vs. 39.3 months, P = 0.0197). In the T3/4 cohort, significantly increased median PFS (13.9 months vs. 36.3 months, P = 0.0217), OS (20.6 months vs. 32.2 months, P = 0.0183) and CSS (21.9 months vs. 38.4 months, P = 0.0226) were obtained in the combination group. Additionally, no severe adverse events (over grade 4) associated with chemotherapy were detected in the RNU + ACT group. In conclusion, ACT after radical surgery has statistically significant therapeutic effects on PFS, OS and CSS in high-risk UTUC patients with cardiovascular comorbidity.

Objective To assess the oncologic outcomes of radical nephroureterectomy (RNU) combined with adjuvant chemotherapy (ACT) in patients with high risk upper tract urothelial carcinoma (UTUC). Methods From January 2014, all high-risk UTUC patients after RNU surgery were enrolled in this prospective comparative trial. And these patients were randomized to ACT group (Gemcitabine+Cisplatin three weeks regimen) and observing group. Cox proportional hazard modeling and Kaplan-Meier analysis were used to determine overall survival (OS), cancer specific survival (CSS) and disease-free survival (PFS) in the cohort. Results The median follow-up duration was36 months (range: 6-54) in the ACT group (n=94) and 30 months (range:6-54) in the observing group (n=82). Oncologic outcomes of RNU treated high-risk UTUC patients were improved much significantly by ACT: OS [P=0.0397, HR: 1.39 (0.91-1.75)], CSS [P=0.0255, HR:1.26(1.07-1.45)] and PFS [P=0.0033, HR:3.78(3.13-4.55)]. The further analysis in lymph node positive cohort displayed that median times of oncologic events were prolonged in the ACT group compared with the observing group: OS (26.8mon vs 36.3mon, P=0.0255), CSS (28.2mon vs 39.3mon, P=0.0197) and PFS (11.4mon vs 31.9mon, P=0.0018). Additionally in T3/4 cohort, the significant growth in the median times of OS (20.6mon vs 32.2mon, P=0.0183), CSS (21.9mon vs 38.4mon, P=0.0226) and PFS (13.9mon vs 36.3mon, P=0.0217) were observed in ACT group. Conclusion ACT could play the important synergistic role in improving the OS, CSS and PFS of high-risk UTUC patients after RNU.

Objective To explore the safety and clinical efficacy of robot-assisted laparoscopic adrenalectomy retroperitoneum and transperitoneal.Methods A retrospective analysis was made of the clinical data of 39 patients with adrenal adenoma treated by robotic surgery via retroperitoneal and transperitoneal approaches in Beijing Anzhen Hospital from Jan.2017 to Dec.2018.Among them,16 patients underwent transperitoneal approach and 23 patients underwent retroperitoneal approach.The clinical data of operation time,intraoperative blood lose,hospitalization days and post-operative hospitalization days were compared between the two groups.Results The operation time was (142 ± 28) min and (107 ± 26) min,respectively,with statistic differences between retroperitoneal and transperitoneal approach (P ＜0.01).The establishment of pneumoperitoneum time was(25 ± 6)min and (19 ± 3)min,respectively,with statistic differences between retroperitoneal and transperitoneal approach (P ＜ 0.01).The post-operative hospitalization days were (8 ± 2)d and(7 ± 1)d respectively,with statistic differences between retroperitoneal and transperitoneal approach (P =0.009).There were no statistic differences in intraoperative bleeding lose and average hospitalization day between the two groups (P ＞ 0.05).Conclusions For robot-assisted laparoscopic adrenalectomy,the retroperitoneal approach has the advantages of shorter operation time,less trauma and faster recovery than the transperitoneal approach.

Objective: To investigate the effect of the derepression of chemokine receptor-7 (CXCR7) in prostatic tissues from patients with Castration Resistant Prostate Cancer (CRPC) on the resistance to enzalutamide (Enza). Methods: During the period of January 2015 to December 2017 all CRPC cases who underwent radical radiotherapy or androgen deprivation therapy (ADT) were evaluated. After prostatic puncture biopsy, the tissues were treated for immunostaining with CXCR7. Cox proportional hazard modeling and Kaplan-Meier analysis were used to determine PSA Progression-Free Survival (PSAP-FS) and Clinical or Radiographic Progression-Free Survival (CRP-FS) in the cohort. At last, PSA response rates and progression outcomes in CXCR7 negative cases and CXCR7 positive cases were analyzed. Results: Total 39 CRPC patients were enrolled in this study. And 23 cases derepress CXCR7, 16 cases negatively express CXCR7. The median follow-up duration was 12 months (range: 6-18) in the cohort. Chi-square analysis confirmed that PSA response rates after Enza treatment were significantly associated with CXCR7 derepression (χ(2)=22.129, P=0.000 06). Compared with CXCR7 positive expression group, CXCR7 negative expression group displayed improved median PSAP-FS (4.4 mon vs 11.7 mon, P=0.040 8) and CRP-FS (5.2 mon vs 13.1 mon, P=0.036 2) after Enza treatment. Conclusion: Derepression of CXCR7 in CRPC patients may be associated with resistance to enzalutamide. This protein may be novel target for treatment of CRPC.

Objective: To assess the oncologic outcomes of radical nephroureterectomy (RUN) combined with adjuvant chemotherapy (ACT) in patients with high risk upper tract urothelial carcinoma (UTUC). Methods: One-hundred-thirty-four individuals with high-risk UTUC who underwent RUN with or without ACT were evaluated. Cox proportional hazard model and Kaplan-Meier analysis were used to determine overall and cancer specific survival in the cohort. Results: The median follow-up duration was 24 months (range: 6-36) in the RUN group (n=61) and 18 months (range: 6-36) in the RUN+ACT group (n=73). Median time of overall survival (OS) and cancer specific survival (CSS) showed much better in RUN+ACT group than in RUN group, but the differences were not reached the significant standard. The further analysis in lymph node positive cohort displayed that median times of oncologic events were prolonged in the RUN+ACT group compared with the RUN group: OS (30.1 mon vs 18.0 mon, P=0.083) and CSS (29.2 mon vs 18.6 mon, P=0.047). Additionally in T3/T4 cohort, the significant growth in the median times of OS (25.2 mon vs 12.6 mon, P=0.038) and CSS (31.3 mon vs 18.9 mon, P=0.044) were observed in combination treatment group. Conclusion: ACT could play the important synergistic role in improving the OS and CSS of RUN treated UTUC patients with lymph node-positive or stage of T3/T4.

Objective: To investigate the oncologic outcome and PSA kinetics of localized high-risk prostate cancer (PCa) patients treated with combination strategy of radiation therapy (RT) and maximal androgen blockade (MAB). Methods: We retrospectively reviewed the clinical data of 320 localized PCa patients undergoing RT+ MAB from 2001 to 2015. And radiation treatment protocol consisted of permanent prostate brachytherapy (PPB) at 110 Gy and EBRT at 45 Gy/23 fractions. Results: The median follow-up time was 90 (range: 12-186) months. And 117 (36.6%) cases underwent MAB + external-beam radiotherapy (EBRT), and other 203 (63.4%) cases received MAB+ EBRT+ PPB. Multivariate Cox regression analyses showed that PSA kinetics were positive indicators of oncologic outcomes. Furthermore, PSA kinetics were aberrantly improved by supplemental PPB to MAB+ EBRT as following, PSA nadir (1.3±0.7)μg/L vs(0.11±0.06)μg/L, time of PSA decrease to nadir (7.5±1.8)months vs (3.2±2.1)months, PSA doubling time (15.6±4.2)months vs (22.6±6.1)months, PSA decreasing amplitude (84.6±6.2)%vs(95.8±3.4)%. Additionally, the median time of several important oncologic events in MAB+ EBRT+ PPB group were also prolonged than that in MAB+ EBRT group as following, overall survival (12.3 years vs 9.1 years, P<0.001), biochemical recurrence-free survival (9.8 years vs 6.5 years, P<0.001), skeletal-related event (10.4years vs 8.2 years, P<0.001), and cytotoxic chemotherapy (11.6 years vs 8.8 years, P=0.007). Conclusion: MAB+ EBRT+ PPB is extremely effective combination strategy for localized high-risk PCa patients, and PPB plays the important synergistic role in improving PSA kinetics, which are independent predictor for oncologic outcomes.

Objective To summarize the effects of aspirin withdrawal time on the recovery of patient underwent transurethral resection of prostate (TURP).Methods The clinical data of BPH patients underwent TURP in our department between 2010 and 2015 were reviewed.According to the patients whether taken Asprin and the Asprin withdrawal time,these patients were divided into three groups:group 1,stop Asprin during perioperative period for 7 days;group 2,stop Asprin during perioperative period more than 7 days;control group,not taken Asprin.The volume of prostate,operating time,intraoperative bleeding amount,the length of hospital stay,the length of hospital stay after operation,the case of blood transfusion,hemoglobin decline in the first day after operation,the weight of resected prostate,the time of bladder irrigation and catheter removed after surgery,and the complication of cardio-cerebral vascular in perioperative period were compared.Results There were no significant differences in operation time,intraoperative bleeding amount,hemoglobin decline,the time of bladder irrigation,the time of catheter removed,and the length of hospital stay between the three groups (P＞0.05).No severe cardio-cerebral vascular events occurred in all patients during the perioperative period.Conclusion Stop taking Asprin before TURP operation for 7 days is effective to reduce the bleeding and cardio-cerebral vascular complications.

Objective To summarize the experiences oftransurethral resection of prostate(TURP) in the treatment of prostatic hyperplasia patients with coronary stent.Methods The clinical data of 56 BPH patients with coronary stent underwent TURP in our department between 2010 and 2015 were reviewed,aging from 57-86 years and 72 years in average.All patients were treated with TURP operation with fully periopemtive preparation including assessment of the risk of surgical anesthesia,blood pressure,cardiac function improvement and suspending the anticoagulation.Results All of the operations were performed successfully without severe complications during the perioperative period.No cardiovascular and cerebrovascular complications and death occurred.The international prostate symptom scores (IPSS) reduced from (26±5) to (12 ±5),and quality of life scores (QOL) reduced from (5.1 ±0.8) to (1.9±1.1) postoperatively.Conclusion With fully preoperative preparation,TURP is safe and effective for patients with BPH and coronary sent.

Objective To explore the clinical pathological characteristics and prognostic features of incidental prostatic carcinoma after transurethral resection of prostate (TURP) and to improve the recognition in the diagnosis and treatment of incidental prostate cancer.Methods Five hundred and eighty patients who underwent TURP from Jan.2009 to Dec.2016 in Beijing Anzhen hospital were analyzed retrospectively.The general and clinical pathological data of patients suffer with incidental prostate cancer were collected in hospital.The age,preoperative PSA level,prostate volume and the weight of the resected prostate in two groups were compared between benign prostatic hyperplasia and incidental prostatic carcinoma;All the patients with incidental prostate cancer were divided into stage T1a and T1b group.The preoperative PSA level,prostate volume,the weight of the resected prostate,Gleason score and prognosis were compared between the two groups.Results Sixteen cases of incidental prostate cancer were detected and the detection rate of incidental prostate cancer after the TURP was 2.8％ (16/580).There was no significant difference in preoperative PSA level,prostate volume and the weight of the resected prostate between the two groups of prostate hyperplasia and incidental prostate cancer;7 cases of incidental prostate cancer patients belonged to T1 a (1.2％) and 9 cases belonged to T1 b (1.6％).The Gleason score in stage T1 a was significantly lower than stage Tlb in incidental prostate cancer patients.There was no significant difference in preoperative PSA level,F-PSA/T-PSA,prostate volume and the weight of the resected prostate between stage T1a and T1b groups.All the patients accepted maximal androgen deprivation therapy.The mean follow-up time was (50.3 ± 25.9) months.The PSA level was decreased by 85.1％ and 97.5％ in stage T1a patients after there and six months after TURP,while 86.9％ and 96.3％ in stage T1b patients.One patient died of acute myocardial infarction in T1a incidental prostate cancer patients and one patient die of renal failure in I1b during the follow-up period.There were no cases of prostate cancer specific death.Conclusions The detection rate of incidental prostate cancer after the TURP was 2.8％,and maximal androgen deprivation therapy for incidental prostate cancer is effective and safety.

Objective To investigate the incidence and risk of acute Cerebral infarction after laparoscopic adrenalectomy of the patient with primary aldosteronism.Methods A retrospective analysis was performed on the patients with primary aldosteronism underwent laparoscopic adrenalectomy in our hospital during Jan.2009 to Jun.2016.Results The clinical data of 151 patients suffered with primary aldosteronism underwent laparoscopic adrenalectomy in our department were reviewed, aging from 25-77 years and (52 ± 12)years in average.All of the 151 cases of patients, 149 cases of patients combined with hypertension, 26 cases of patients combined with coronary disease, 34 cases of patients combined with diabetes and 11 cases of patients suffered from cerebral infarction at previous time.There are three patients suffered from acute cerebral infarction after laparoscopic adrenalectomy at 1-3 months.All of the three patients combined with hypertension and cerebral infarction history.Conclusions The patients have a probability to suffer from acute cerebral infarction after laparoscopic adrenalectomy due to the fluctuation of blood pressure, but the risk is relatively low.The patients with the high risk of cerebral infarction should enhance the postoperative management.

目的分析近20年来耻骨上经膀胱前列腺切除术在治疗前列腺增生症（BPH）患者的临床应用效果变化。方法回顾性分析1992年1月—2012年1月首都医科大学附属北京安贞医院收治的216例行耻骨上经膀胱前列腺切除术的BPH患者的临床资料,根据治疗时间分为前10年组（n=100）和后10年组（n=116）,对比分析两组患者的平均住院时间、住院费用、手术时间、术中出血量和术中及术后并发症等指标的差异。结果与前10年组比较,后10年组患者住院时间和手术时间缩短,住院费用增加,术中出血量减少,术中及术后并发症减少,差异均有统计学意义（P＜0.05）。结论随着医疗水平的不断提高,耻骨上经膀胱前列腺切除术并发症越来越少,手术及住院时间缩短,手术质量不断上升,患者更加受益。

Luo Yong1#, Li Mingchuan1#, Qi Hengzhi1, Wei Nengbao1, Zhao Jiahui1, Cui Xinhao1, Han Yili1, Lin Yunhua1, Hou Zhu1, Jiang Yong-guang1* and Zhang Jiao2* 1Department of Urology, Beijing Anzhen Hospital, Capital Medical University, Anzhenli Street, Chaoyang District, Beijing, 100029, PR. China 2Anatomy and Cell biology, East Carolina University, Greenville, NC, USA, 27834 #Luo Yong and Li Mingchuan contribute equally to this work.