Objective To compare the therapeutic efficacy of robot-assisted laparoscopic radical prostatectomy versus conventional laparoscopic radical prostatectomy, and analyze the factors influencing treatment outcomes. Methods A retrospective cohort study was conducted on 719 patients (total cohort) who underwent radical prostatectomy in our department from June 2002 to October 2023. According to different surgical methods, they were divided into robot-assisted laparoscopic radical prostatectomy group (robotic group, n=409) and conventional laparoscopic radical prostatectomy group (conventional group, n=310). Clinical characteristics, biochemical recurrence rates, and recovery of urinary continence at 1, 3, 6, and 12 months postoperatively, as well as sexual function recovery at 6 and 12 months after surgery, were compared between the 2 groups. Additionally, the factors influencing biochemical recurrence and urinary continence recovery were analyzed across the entire cohort. Results In the cohort, the robot group demonstrated significantly larger proportions of pathological high T stages (≥pT3, P < 0.01), increased positive lymph node rate (P < 0.01), and greater number of dissected lymph nodes (P < 0.01) than the conventional group. There were no statistical differences between the 2 groups in terms of Gleason score, biochemical recurrence rate, or incidence and type of complications. The robot group exhibited significantly higher rates of urinary continence recovery at 1 (P=0.004), 3 (P < 0.01), 6 (P=0.002) and 12 months (P=0.004) postoperatively. But no obvious difference was seen in the score of International Index of Erectile Function-5 (IIEF-5) between the 2 groups at 6 and 12 months. Across the entire cohort, pathological high T stage (≥pT3, P < 0.01), high Gleason score (>7, P=0.036), fewer lymph nodes dissected (≤10, P < 0.01), and positive lymph nodes (P=0.046) were independent risk factors for biochemical recurrence. Additionally, the surgical method, specifically robot-assisted laparoscopic radical prostatectomy, was identified as a significant factor influencing urinary continence recovery at 12 months postoperatively (P=0.005). Conclusion Compared to conventional laparoscopic radical prostatectomy, robot-assisted laparoscopic radical prostatectomy shows certain effect on reducing biochemical recurrence rate and enhancing recovery of urinary continence in prostate cancer patients at 1, 3, 6 and 12 months postoperatively.

目的 膀胱原发性淋巴瘤是临床相当罕见的一种疾病,阐述其病例特点.方法 通过回顾该中心收治的 2 例膀胱原发淋巴瘤的诊治经过,并结合相关文献,总结目前膀胱原发淋巴瘤的病例特点.结果 膀胱原发淋巴瘤常见的类型为黏膜相关淋巴组织淋巴瘤和弥漫性大 B 细胞淋巴瘤,也零星有间变性大细胞淋巴瘤等其他类型的膀胱原发非霍奇金淋巴瘤的报道.本文通过回顾病例资料及既往文献,总结了其不同病理亚型的临床表现、发病机制、影像学表现、治疗方案、预后因素等特点,为相关学科的临床医师就本病的诊断及治疗提供参考.结论 膀胱原发淋巴瘤不同于其他类型的膀胱恶性肿瘤,外科手术的获益较小.因此,准确地识别和分期以及组织学确认会显著影响这些患者的管理.通过学习,相关学科的医师能够减少此类患者的延误诊断,具有重要意义.

Objective To summarize our surgical techniques and clinical experience of robot-assisted laparoscopic radical nephrectomy (RARN) and open radical nephrectomy (ORN) plus inferior vena cava thrombectomy (IVCT), and compare the clinical outcomes and safety of the 2 procedures. Methods A retrospective cohort study was conducted on 26 patients diagnosed with renal tumor complicated with inferior vena cava tumor thrombus who underwent radical nephrectomy plus inferior vena cava thrombectomy in our department from 2012 to 2022. Among them, 12 patients were conducted with ORN plus IVCT (O-IVCT), including 3 cases having cardiopulmonary bypass, and the other 14 patients received RARN plus IVCT (RA-IVCT), of them 2 cases experienced conversion to open surgery. Surgical characteristics, such as operative time, intraoperative duration for blocking the vena cava, intraoperative bleeding volume, postoperative length of hospital stay and rates of intraoperative blood transfusion and postoperative conversion to ICU were compared between the 2 groups. Results The average operative time was 394±141 min in all cases, and the time of blocking the inferior vena cava was 23.90±6.95 min excluding 3 cases undergoing cardiopulmonary bypass. There were no significantly differences in the average age, body mass index (BMI), tumor size, pathological T stage, or tumor thrombus level by Mayo classification between the RA-IVCT and O-IVCT group. The patients from the RA-IVCT group had a median intraoperative bleeding volume of 600 (50~1 600) mL, significantly less than that in the O-IVCT group [1 100 (600~3 800) mL, P=0.049]. No statistical differences were observed between the RA-IVCT group and O-IVCT group in following indicators: mean operative time (323±102 vs 401±95 min, P=0.089), mean duration of blocking the inferior vena cava (26.10±7.03 vs 20.20±6.16 min, P=0.057), rate of blood transfusion (8/12 vs 8/9, P=0.338), rate of ICU admission (3/12 vs 6/9, P=0.087), or median length of hospital stay after surgery [7(4~14) vs 8(7~20) d, P=0.091]. Conclusion RA-IVCT is a safe and effective operation, with the advantage of less intraoperative bleeding volume when compared with O-IVCT.

ObjectiveTo investigate the clinical characteristics of fumarate hydratase-deficient renal cell carcinoma（FH-RCC）in kidney transplant patients so as to improve the diagnosis and treatment of the disease clinically.MethodsWe retrospectively analyzed and summarized the clinical data of one kidney transplanted patient with FH-RCC who was treated in the urological department of our medical center in March 2022, including clinical characteristics, treatment and prognosis. A literature review was also performed to analyze and summarize its characteristics.ResultsA 52-year-old female patient who received a kidney transplant 20 years ago was diagnosed with right kidney cancer with multiple metastases. Cytoreductive nephrectomy was performed and pathological type was FH-RCC based on Revised Version of WHO 2022 Classification of Renal Tumors. She then received targeted therapy until discontinuation due to elevated serum creatinine and the disease progressed rapidly.ConclusionFH-RCC is characterized by rapid progress and poor prognosis. Its diagnosis relies on immunohistochemistry and genetic test. There are no currently standard-of-care treatment options for kidney transplant patients with renal cell carcinoma. Individualized treatment regimens should be suggested for these patients.

Objective To analyze the risk factors for biochemical recurrence in prostate cancer patients after radical prostatectomy (RP) and establish a risk prediction model for the recurrence. Methods A retrospective cohort study was conducted on 279 patients who underwent RP surgery in our hospital from September 2007 to March 2022. There were 21 clinical indicators collected and analyzed. After time factors were included, Lasso regression was applied to screen the indicators, Kaplan-Meier method was used to draw survival curve, univariate and multivariate Cox proportional risk regression models were employed to analyze the risk factors and establish a prediction model. Then receiver operating characteristic (ROC) curve were plotted to evaluate the discriminative performance of the model. Then a nomogram was draw based on the obtained risk factors. Calibration curve was used to evaluate the accuracy of prediction, and decision curve was employed to assess the clinical benefit. Results During a median follow-up time of 37.10 (17.60, 61.30) months, 86 cases (30.8%), at a median age of 68.00 (65.00, 72.00) years, experienced biochemical recurrence. Univariate analysis showed that 12 indicators were strongly associated with biochemical recurrence after RP (P < 0.05), and Lasso regression screening indicated 7 representative indicator sets, including nutritional risk index (NRI), clinical T-stage, pathological Gleason score, pathological T-stage, positive surgical margin, lymph node invasion, and seminal vesicle invasion. Further multifactorial analysis revealed that pathological high stage (≥pT3 stage) (HR=1.895, 95%CI: 1.045~3.435, P=0.035), positive surgical margin (HR=1.808, 95%CI: 1.006~3.25, P=0.048), lymph node invasion (HR=2.161, 95% CI: 1.118~4.175, P=0.022) and NRI ≤106.9 (HR=0.598, 95% CI: 0.378~0.946, P=0.028) were independent risk factors for biochemical recurrence. The predictive equation was established with an AUC of 0.743 (95% CI: 0.677~0.810, P < 0.001), a sensitivity of 0.826 and a specificity of 0.534. And the established nomogram has a C-index of 0.741 (95%CI: 0.677~0.805; P < 0.001), with good agreement indicated by calibration curve. Clinical decision curve displayed that there was a net benefit when the threshold probability was 15%~85%. Conclusion High pathological stage (≥pT3 stage), positive surgical margin, lymph node invasion, and NRI ≤106.9 are independent risk factors for biochemical recurrence of prostate cancer after RP. Our prediction model can make effective judgments and provide references for clinical decision making.

目的 探讨加速康复外科(ERAS)理念在根治性膀胱切除术和尿流改道围手术期中的应用价值.方法 选取2015年6月至2020年6月于该中心接受"腹腔镜下根治性膀胱切除术+盆腔淋巴结清扫+回肠代膀胱腹壁造口术"治疗的膀胱癌患者58例,其中27例予以传统康复治疗(传统组),31例予以ERAS治疗(ERAS组).比较两组术前基本资料及病理分期,以及术后首次进水时间、首次排便时间、住院时间、肠外营养和抗生素使用时间、引流管留置时间及并发症发生情况等.结果 与传统组比较,ERAS组术后首次进水时间[(0.71±0.24)d vs.(3.28±0.73)d]、首次排便时间[(2.72±0.69)d vs.(4.55±1.07)d]、术后住院时间[(9.0±3.l)dvs.(18.0±6.8)d]、肠外营养使用时间[(4.4±2.6)d vs.(7.9±4.4)d]、抗生素使用时间[(3.2±2.6)d vs.(13.4±5.6)d]、引流管留置时间[(5.4±2.4)dvs.(11.6±5.6)d]均缩短,差异有统计学意义(P＜0.05).两组术后感染、术后出血、肠梗阻及尿瘘等并发症发生率均无明显差异(P＞0.05).结论 ERAS应用于膀胱癌根治术可有效缩短患者住院时间和肠外营养使用时间,促进患者术后恢复,在膀胱癌治疗中有一定的应用价值.

Background Genetic profiling of patients with prostate cancer could potentially identify mutations prone to castration-resistant prostate cancer (CRPC). Here, we aimed to identify the differences in genetic profiles of patients with hormone-sensitive prostate cancer (HSPC) and CRPC and stratify HSPC patients to identify mutations associated with CRPC progression. Methods A total of 103 samples were collected, including 62 DNA samples from the tumor tissues of 59 HSPC patients and 41 cell-free DNA (cfDNA) samples from prostate cancer patients at different cancer stages. Targeted sequence was conducted on both the tissue DNA and cfDNA. The associations between mutations and clinical outcomes (CRPC-free time) were analyzed using χ 2 test, logistic regression analysis, Kaplan–Meier analysis, and Cox regression analysis. Results By comparing to that of cfDNA sequencing, the results from DNA sequencing of 1-needle (80%) and mixed 12-needle (77.8%) biopsies are highly comparable. FOXA1 (30.5%), CDK12 (23.7%), and TP53 (22.0%) were the top 3 most frequently mutated genes in HSPC patients; 50.8% (30/59) and 44.1% (26/59) HSPC patients had mutations in DDR and HRR pathway, respectively. Mutations in AR and APC as well as the members involved in the regulation of stem cell pluripotency and EMT pathway were often observed in CRPC samples. We established a panel of four genetic mutations (MSH2, CDK12, TP53, and RB1) to predict the risk of CRPC early progression with concordance index = 0.609 and the area under curve of the ROC curve as 0.838. Conclusions In this study, we demonstrated that the cfDNA can be used in genetic profiling in prostate cancer and our newly established panel is capable of predicting which mHSPC patient has a high risk of early CRPC progression.

Objective To preliminarily investigate the safety and effectiveness of robot-assisted kidney transplantation (RAKT) in the perioperative period. Methods Clinical data of 14 patients undergoing renal transplantation in our department from June 2018 to March 2022 were collected and retrospectively analyzed. They were 8 males and 6 females, and at an age of 22 to 45 years. There were 4 patients receiving robotic-assisted laparoscopic living-donor kidney transplantation (RAKT group), and 10 cases receiving open kidney transplantation (OKT group) with deceased donor kidney. Arterio-venous anastomoses (AVAs) time, length of post-operative stay, pre- and post-operative serum creatinine levels, intraoperative blood loss, and incidence of post-operative complications were retrospectively analyzed between the patients of the 2 groups. Results The surgeries went well in the 14 patients. The amount of intraoperative blood loss was 162.5±47.8 mL in the RAKT group and 245.1±68.5 mL in the OKT group(P < 0.05). The arterial anastomosis time was 32.5±6.5 min in the RAKT group and 24.3±5.3 min in the OKT group. The venous anastomosis time was 16.5±3.8 min in the RAKT group and 14.6±1.5 min in the OKT group. The blood creatinine level was 98.1±33.2 μmol/L in the RAKT group and 142.8±42.1 μmol/L in the OKT group in 7 d after surgery. The retention time of drainage tube was 10.0±1.2 d in the OKT group and 6.5±0.5 d in the RAKT group(P < 0.01). The length of stay after surgery was 13.0±2.5 d in the RAKT group and 16.3±2.1 d in the OKT group(P=0.01). Conclusion RAKT is safer than OKT in the perioperative period and causes fewer postoperative complications.

目的 总结6例机器人辅助腹腔镜下腹膜后淋巴结清扫术,对该手术的技巧方法和经验教训进行初步探讨.方法 患者均为青年男性,睾丸胚胎癌根治术后,行机器人辅助腹腔镜下腹膜后淋巴结清扫术.手术体位采用健侧斜侧卧位+轻度折刀位,穿刺孔取脐旁为观察孔,常规取3个机器人操作手臂及2个助手孔,手术范围为标准清扫范围,清除所有患侧腹膜后淋巴组织.结果 手术成功完成,术中出血100～250 ml,术后恢复良好.术后病理未发现淋巴结转移.结论 机器人辅助腹腔镜下腹膜后淋巴结清扫术相对难度高,手术体位和穿刺孔的选择对手术成功与否至关重要,其精准和灵活的操作可以使患者明显受益,对交感干、腹主动脉及其分支、腔静脉及其分支的保护优于普通腹腔镜.

目的 探讨后腹腔镜下不阻断肾动脉行保留肾单位肾脏肿瘤切除术的手术方法可行性及安全性,减少后腹腔镜下保留肾单位手术对肾脏功能的影响.方法 对16例＜4 cm的肾脏周边型肿瘤行后腹腔镜下不阻断肾动脉方法保留肾单位肾脏肿瘤切除术.建立传统四通道后腹腔腔隙,寻找并游离肾动脉不予阻断,充分游离整个肾脏并暴露肿瘤,于肿瘤边缘0.3～0.5 cm用剪刀开始切除肿瘤,遇可疑血管及活动出血用双极电凝(PK刀)止血,助手用吸引器保持创面清晰;完整切除肿瘤后用结扎夹代替打结的方法连续缝合创面,最后创面喷洒生物蛋白凝胶.结果 14例手术取得成功,2例因出血难以控制采用暂时阻断肾动脉后完成手术,无中转开放.手术时间65～150min,平均86 min;出血量50～550ml,平均240ml;术后住院时间7～10 d,平均9d;术后无肾脏继发出血、漏尿等外科并发症.结论 后腹腔镜下不阻断肾动脉行保留肾单位肾脏肿瘤切除术对肾周表浅T1a期肿瘤安全可行,有较好的临床应用价值.

目的探讨磁共振波谱成像（MRS）联合前列腺特异性抗原（PSA）比值（fPSA/tPSA）及PSA密度（PSAD）在PSA灰区（4~10ng/mL）对前列腺癌（PCa）的诊断价值。方法选取PSA位于灰区,病理检查证实为前列腺增生（BPH）或PCa的男性患者60例,收集tPSA、fPSA数据,计算PSAD、fPSA/tPSA、（胆碱+肌酸）/枸橼酸盐的数值,用受试者工作特征（ROC）曲线分析MRS联合PSAD及fPSA/tPSA对PCa的诊断价值。结果 PCa组（n=24）和BPH组（n=36）的年龄和tPSA差异无统计学意义（P＞0.05）;fPSA、fPSA/tPSA、前列腺体积、PSAD和MRS的差异均有统计学意义（P＜0.05）;MRS、PSAD和fPSA/tPSA诊断PCa的效果相似（P＞0.05）;MRS与PSAD或fPSA/tPSA联合后对PCa诊断效能无明显增加（P＞0.05）;MRS、PSAD和fPSA/tPSA三者联合后,诊断效能显著增加（P＜0.05）。结论 MRS联合PSAD及fPSA/tPSA可提高灰区PCa诊断的准确性,对灰区PCa诊断有较高应用价值。

Objective To explore the feasibility of laparoendoscopic single-site epinephroectomy through retroperitoneal approach. Methods Eight patients, including 5 cases of adrenal hyperplasia and 3 cases of adenoma, underwent retroperitonral laparoendoscopic single-site epinephroectomy. In all cases, a 2.5 cm single longitudinal incision was made along the midaxillary line 4-5 cm above the iliac crest. Two 5 mm and one 10 mm trocars were inserted, and medical rubber glove was sutured surrounding these trocars and incision for gas proofing. Flexible electric coagulation hook and plier were used for dissection. The adrenal central vein was held by Hem-o-lock clamps. Results All operations were successfully completed. The mean operating time was 95 (55-135) minutes. The mean estimated blood loss was 85 (50-150) ml. The total drainage volume after operation was less than 100 ml in all case. Follow-up results after 1 to 4 months demonstrated that, blood pressure in all patients decreased respectively and returned to the normal range in 5 cases. Slow cicatrization of incision occured in only 1 case. Conclusions Retroperitoneal laparoendoscopic single-site epinephroectomy is verified to be safe and feasible, and the operation outcome is proved to be effective.

Objective:To probe to the feasibility of performing nephrectomy by single-port and three tunnels retroperitoneal laparoscopic technique.Methods:2 cases with adult non-functioning kidney underwent the single-port and three tunnels retroperitoneal laparoscopic nephrectomy.A single 3cm incision was situated in postaxillary line under the 12 rib,and retroperitoneal working space was established.The domestic trocar for single-port with three tunnels was placed in retroperitoneal space.The diameter of laparoscopic tunnel is 5mm,and the other two are 12mm and 5mm.Nephrectomy was performed with ultrasound knife,suction apparatus,flexible clamp and scissor.Results:All procedures were technically successful.The operating time was 156 and 174 minutes.The estimated blood loss was 100 and 150 mL.The length of hospital stay were all 7 days.2 cases with only one 3cm scar on the lumbar.No intraoperative and postoperative complications occurred.Conclusions:Based on E-NOTES, the feasibility of establishing retroperitoneal working space and performing renal operations by single-port and three tunnels retroperitoneal laparoscopic technique is validated.With the development of technique and equipment, it offers a new effective and prospect minimally invasive treatment for selected patients.

Objective To evaluate the efficacy of single-port retroperitoneal laparoscopic renal cystectomy.Methods 18 cases with renal cyst underwent the single-port retroperitoneal laparoscopic renal cystectomy.Results All procedures were techni-cally successful.The mean operating time was 23(11-42) minutes.The mean estimated blood loss was 26(10-50) ml.All patients with only one 2.5 cm scar on the lumbar recover out-of-bed activity after anesthesia.The mean hospital stay after surgery was 1.2 days.No intraoperative complications occurred.No local recurrence was observed during a mean follow-up of 3.4 months.Conclusions Single-port retroperitoneal laparoscopic renal cystectomy is a feasible option for patients with renal cyst.It offers a new effective and minimally invasive treatment for selected patients.However,the long-term effects of the procedure need further investigation.