OBJECTIVE:A new type of CT-guided puncture device (CT-GPD) has been developed. We aimed to evaluate and compare the puncture accuracy and stone-free rates (SFRs) for percutaneous nephrolithotomy (PCNL) between the CT-GPD puncture group, the X-ray-guided group, and the free-hand CT-guided (FH-CTG) group. METHODS:From September 2023 to September 2024, 51 patients were divided into CT-GPD, FH-CTG, and X-ray-guided groups to perform PCNL. Basic patient data, procedure details, radiation exposure, puncture time, complications, and SFRs were recorded and analyzed. RESULTS:There was no significant difference in the patients' demographics, including age, sex, body mass index, and stone characteristics, among the three groups. The indices of puncture time, puncture success rate, and the number of punctures in the CT-GPD group were 10.88 ± 2.07 minutes, 100%, and 1.82 ± 0.73, respectively, which were significantly better (p < 0.05) than the other two groups. Compared with the FH-CTG group, the effective dose and the number of CT scans in the CT-GPD group were reduced by 11.2% (p = 0.006) and 23.6% (p = 0.006), respectively. CONCLUSION:CT-GPD is a valuable tool for establishing PCNL access. It may increase puncture accuracy, reduce radiation exposure, and avoid injury to the renal vascular and surrounding soft tissue without sacrificing the SFRs. This device may be especially beneficial for novices in PCNL.

The purpose of this study is to evaluate the incidence, risk factors, and salvage management of retrievable covered expandable metallic stent (RCEMS) migration in patients with persistent benign ureter strictures. A retrospective study was performed on 117 consecutive patients who underwent implantation of RCEMS. Univariate and multivariate analyses were used to identify prognostic factors for stent migration, including stricture location and length, hydronephrosis–cortex ratio, ureteral dilation, and the diameter of the narrowest portion of the stricture. Stent migration occurred in 22 (19.5

The effectiveness of metallic stents in treating ureteral strictures following surgery and radiotherapy for gynecological tumors is currently uncertain. We aimed to investigate the efficacy and safety of thermo-expandable metallic stent (Memokath) in the treatment of ureteral stricture after radiotherapy for gynecological tumors. In this descriptive cross-sectional study, 27 patients with ureteral stricture were treated with Memokath stent after gynecological tumor radiotherapy with or without chemotherapy that was admitted to our hospital from August 2021 to August 2023. Clinical data on efficacy, safety, and complications during stent insertion and indwelling were analyzed. The successful insertion of thirty-three stents in twenty-seven patients studied. The stenosis length was 10.14 ± 6.76 cm, and the hospitalization was 4.43 ± 1.83 days. One patient has died from the primary disease carrying a patency stent. The Kaplan-Meier graph showed that the cumilative patency rate of patients with thermo-expandable metallic stent were 92.4

Renal calyceal neck atresia is a rare disorder. There is no clear guidance for standard treatment of this condition. The Memokath™ 045 temperature-controlled memory alloy stent is commonly used in the treatment of urethral strictures, but it has not been used for treating calyceal neck atresia. We present a case of a 44-year-old female patient with left lumbar pain who underwent two stages of treatment to resolve calyceal neck atresia located at the upper calyx of her left kidney. The first procedure was transurethral ureteroscopy combined with percutaneous recanalization of the left upper calyx calyceal neck atresia. One 6 F internal stent and one 8 F internal stent were placed, and she was discharged with a left nephrostomy tube. After her urinary tract infection was fully resolved, the patient returned for the second procedure of percutaneous upper renal calyx calyceal neck metal stent implantation. The temporary stents and nephrostomy tube were successfully removed. Our findings suggest that the Memokath™ 045 temperature-controlled memory alloy stent is an effective choice for treating calyceal neck atresia.

Aggressive fibromatosis is a rare and benign stromal tumor. Aggressive fibromatosis is characterized by mesenteric fibrous hyperplasia. Although aggressive fibromatosis occasionally invades intestine or adjacent tissues with invasive myofibroblast proliferation, it lacks the ability of malignant tumorigenesis and distant metastasis. Aggressive fibromatosis associated ureteral stricture is a rare urinary disease. This paper reported a case of aggressive fibromatosis of ureter admitted to The Fifth Affiliated Hospital of Guangzhou Medical University in May 2021.

目的 探讨双根D-J管联合球囊扩张术在治疗良性输尿管狭窄的疗效,分析其安全性及有效性.方法 通过回顾分析本单位12例良性输尿管狭窄围手术期患者及随访相关资料.所有患者诊断为良性输尿管狭窄,患侧输尿管接受了巴德球囊扩张术,放置两根4.8F输尿管内支架管,留置时间为3个月.取出支架后行输尿管镜检术评估输尿管狭窄情况及此后第1、3、6个月复查泌尿系B超明确积水有无较前加重.结果 12例患者中男性8名,女性4名,平均年龄为36.3±10.9岁.其中左侧输尿管狭窄7例,右侧输尿管狭窄5例.上段输尿管狭窄3例,中段输尿管狭窄7例,下段输尿管狭窄2例.输尿管狭窄平均长度为1.19±0.47cm.12例患者均于置管后3个月拨管,经镜检未见明显狭窄,所有患者在取除内支架管后第1个月未出现肾积水加重.1例患者在取除内支架管后第3个月出现肾积水轻度加重.2例患者在取除内支架管后第6个月出现肾积水轻度加重,第1例复发患者肾积水较第1个月增加0.8 cm.第2和第3例患者(新增)较第3个月肾积水增加分别为0.3 cm和0.4 cm.结论 对于良性输尿管狭窄,双根"D-J"管置入可使得引流更通畅,可有效防止输尿管狭窄扩张术后的再次复发.

Renal angiomyolipoma (RAML), also referred to as renal hamartoma, is a rare benign tumor. There are two types of RAML, which include the tuberous sclerosis complex (TSC)-associated type and the sporadic type. TSC is an autosomal dominant genetic disease characterized by the growth of benign tumors in the skin, brain, kidneys, lung and heart. TSC leads to organ dysfunction, as the normal parenchyma is replaced by a variety of cell types. The current study presents a case of giant RAML in a 20-year-old female, who was hospitalized for epileptic seizures. Large abdominal lesions were detected during hospitalization. Subsequently, she underwent open mass resection and right kidney partial resection. Postoperative pathological examination confirmed that the mass was angiomyolipoma.

OBJECTIVE:To identify the key genes associated with the pathogenesis of PCa using the bioinformatics approach for a deeper insight into the molecular mechanisms underlying the development and progression of PCa.METHODS:The microarray datasets GSE70770, GSE32571 and GSE46602 were downloaded from the Gene Expression Omnibus (GEO) database, and differentially expressed genes (DEG) in the normal prostate tissue and PCa were identified with the GEO2R tool, followed by functional enrichment analysis. A protein-protein interaction (PPI) network of DEGs was constructed by STRING and visualized with the Cytoscape software.RESULTS:A total of 235 DEGs were identified, including 61 up-regulated and 174 down-regulated genes, which were mainly enriched in focal adhesion kinase (FAK), ECM-receptor interaction, and other signaling pathways. From the PPI network were screened out 12 highly connected hub genes, including MYH11, TPM1, TPM2, SMTN, MYL9, VCL, ACTG1, CNN1, CALD1, ACTC1, MYLK and SORBS1, which were shown by hierarchical cluster analysis to be capable of distinguishing prostate cancer from non-cancer tissue.CONCLUSIONS:A total of 235 DEGs and 12 hub genes were identified in this study, which may contribute to a further understanding of the molecular mechanisms of the development and progression of PCa, and provide new candidate targets for the diagnosis and treatment of the malignancy.

输尿管阴道瘘是输尿管损伤后的一种严重并发症,大多数为妇产科手术造成[1,2] ,目前多采用输尿管镜植入双 J 管或开放手术修复输尿管阴道瘘治疗[3].留置双J 管瘘口自愈率低( 5％ ～15％) ,开放手术修复输尿管阴道瘘创伤大,患者难以接受[3].近年来,新型覆膜金属支架已应用在输尿管狭窄的治疗中,这类支架具有覆膜结构以及自膨胀金属局段支撑的特点[4～6].2018年11月～2019年6月我们对6例妇科手术致输尿管阴道瘘采用新型覆膜金属支架( Allium Medical)治疗,现报道如下.

TBL(Team-Based-Learning)是一种小组学习的结构形式,近年来在医学教育中越来越受欢迎.越来越多的医学院在各种环境,学习者和内容领域以各种各样的形式采用了TBL.本文将从TBL的概念提出与发展,在见习和实习中的应用效果以及TBL教学模式在目前教学应用中存在的问题做系统探讨,以向课程计划者和教育设计者提供参考信息.

目的 对应用输尿管软镜(RIRS)治疗上尿路结石的经验进行总结,以评价该技术的安全性及临床疗效.方法 选取2007年6月-2017年6月该院采用RIRS治疗的上尿路结石患者10413例.回顾性分析可拆卸输尿管软镜(n=774)、纤维输尿管软镜(n=2293)和电子输尿管软镜(n=7346)3种软镜治疗上尿路结石的成功率、结石清除率、手术时间、住院时间和手术并发症等差异.结果 可拆卸输尿管软镜、纤维输尿管软镜和电子输尿管软镜一期手术成功率分别为73.00％、82.99％和91.00％.二期手术(一期放置输尿管内支架管)分别为27.00％、17.01％和9.00％.结石清除率分别为87.00％、89.00％和93.00％.平均手术时间分别为(112.0±32.5)、(90.0±24.0)和(75.5±20.5)min.平均住院时间分别为(9.0±1.5)、(7.0±1.0)和(5.0±1.5)d.手术并发症发生率分别为3.62％、1.30％和0.99％.结论 采用RIRS技术治疗上尿路结石安全、有效.随着RIRS技术的不断提高,以及输尿管软镜相关设备的不断优化,提高了该项技术的手术成功率及结石清除率、降低了并发症发生率和缩短了住院天数,RIRS治疗的临床适应证将逐步扩大.

目的 评估新型覆膜金属支架用于移植肾输尿管狭窄的安全性和有效性.方法 回顾性分析2018年12月～2019年10月使用覆膜金属支架治疗的7例移植肾输尿管狭窄的临床资料.结果 7例输尿管狭窄均位于移植肾输尿管膀胱连接部,狭窄段长5～15 mm,平均10 mm,均成功植入覆膜金属支架.6例术前、术后肾功能均正常;1例术前血肌酐455μmol/L,术后3天降至178μmol/L.7例术后3个月复查利尿肾图及尿路造影,提示上尿路引流通畅.随访3～11(6.6±2.6)月.1例术后3个月输尿管狭窄消失,覆膜金属支架排至膀胱,使用输尿管镜经尿道取出.7例均未发生尿路感染、结石形成、下腹痛等.结论 覆膜金属支架治疗移植肾输尿管狭窄安全有效.

Clear cell renal cell carcinoma (ccRCC) is one of the most common malignant tumors in the urinary system. Surgical intervention is the preferred treatment for ccRCC, but targeted biological therapy is required for postoperative recurrent or metastatic ccRCC. Autophagy is an intracellular degradation system for misfolded/aggregated proteins and dysfunctional organelles. Defective autophagy is associated with many diseases. Mul1 is a mitochondrion-associated E3 ubiquitin ligase and involved in the regulation of divergent pathophysiological processes such as mitochondrial dynamics, and thus affects the development of various diseases including cancers. Whether Mul1 regulates ccRCC development and what is the mechanism remain unclear. Histochemical staining and immunoblotting were used to analyze the levels of Mul1 protein in human renal tissues. Statistical analysis of information associated with tissue microarray and The Cancer Genome Atlas (TCGA) database was conducted to show the relationship between Mul1 expression and clinical features and survival of ccRCC patients. Impact of Mul1 on rates of cell growth and migration and autophagy flux were tested in cultured cancer cells. Herein we show that Mul1 promoted autophagy flux to facilitate the degradation of P62-associated protein aggresomes and adipose differentiation-related protein (ADFP)-associated lipid droplets and suppressed the growth and migration of ccRCC cells. Levels of Mul1 protein and mRNA were significantly reduced so that autophagy flux was likely blocked in ccRCC tissues, which is potentially correlated with enhancement of malignancy of ccRCC and impairment of patient survival. Therefore, Mul1 may promote autophagy to suppress the development of ccRCC.

肾结石是泌尿外科最常见的疾病.输尿管软镜碎石取石术(RIRS)是处理中等大小的肾结石较为微创的治疗方法.结石清除率(SFR)是手术最为主要的评价指标之一.传统上,对于残余结石(RF) ＜4 mm的非感染性结石定义为无意义结石.然而,输尿管软镜碎石取石术很大程度上是“碎石为主、取石为辅”的策略,相比于经皮肾碎石取石术“碎-取”同步的策略,既往经皮肾术后的SFR是否仍符合软镜时代下的结石清除率概念,本文将追溯并归纳总结有关输尿管软镜术后的结石的自然史及结石清除率的相关研究.

Objective To evaluate the efficacy and safety of one-step dilation technique in minimally invasive percutaneous nephrolithotomy (MPCNL). Methods Clinical data of 2813 patients who underwent MPCNL by one-step dilation technique from February 2011 to March 2015 was retrospectively analyzed. Results 2813 patients were successfully underwent MPCNL by one-step dilation, including 2383 cases who were accessed by single tracts (84.71%) and 430 (15.29%) cases by multiple tracts. The mean operating time was (78.6 ± 41.1) min, the mean tract accessing time was (2.3 ± 0.8) min.The stone-free rate after one session operation was 78.59%. It improved to 91.50% one month after operation. During and after operation, 93 cases needed transfusion, 21 underwent selective renal artery embolization. Adjacent viscera damage: 9 cases with pleural lesions and 1 case with colon injury, 13 cases with urinary extravasation, perirenal hematoma in 15 cases, without liver and spleen injury. Septic shock in 2 cases, who was recovered after anti-infection treatment. Conclusion One-step dilation is safe and effective technique to establish tracts in MPCNL, which can reduce X-ray exposure and operation time, but does not increase the risk of bleeding.