目的 探讨机器人辅助腹腔镜下前列腺癌根治性切除术(RARP)中保留耻骨前列腺韧带(PPLs)是否能使尿控功能得到更好的恢复.方法 回顾性分析该院2016年8月至2021年8月行RARP的107例前列腺癌(PCa)患者的临床资料,包括年龄、基础病史等基线数据,病理分期分级、淋巴转移及周围累及、术后并发症等围术期数据,术后随访的尿控情况及国际尿失禁咨询问卷尿失禁简表(ICIQ-UI SF)评分,其中标准术式组56例(A组),保留PPLs组51例(B组).对2组以上资料进行统计分析.结果 手术均获成功,无中转开放及患者死亡.2组患者基线资料及术中情况相关数据差异无统计学意义(P＞0.05).术后3个月,A组漏尿频率评分明显高于B组[(2.05士1.30)分vs.(1.53±1.14)分,P=0.046],ICIQ-UI SF总分也明显高于B组[(7.80±3.73)分vs.(6.29±3.70)分,P=0.038].术后1年,A组漏尿量评分[0(0,1)分vs.0(0,0)分,P=0.078]、对生活的影响程度[0(0,2)分vs.0(0,0)分,P=0.014]明显高于B组,ICIQ-UI SF总分也明显高于B组[0(0,5)分vs.0(0,0)分,P=0.01].2组出血量与引流管留置时间比较差异无统计学意义(P＞0.05),但B组的手术时间[175(140,229)min vs.160(140,180)min,P=0.074]与住院时间[(16.66士5.08)dvs.(14.51±5.47)d,P=0.037)]较A组更短.结论 保留PPLs的手术方式安全可行,有助于PCa患者更好地恢复尿控功能,并提高远期的生活质量,值得推广.

BACKGROUND:For patients with lower pole renal calculi (LPC), preoperative evaluation of infundibulopelvic angles (IPA) is of great significance; however, conventional measuring method is often inconvenient in clinical setting. Here we introduce a rapid novel method using built-in inclinometer in smartphone which is often used in anatomical parameters evaluating to implement the measurement of IPA.MATERIALS AND METHODS:The randomized, self-controlled study on evaluating inclinometer application measured IPA on urography films collected from enrolled LPC patients. Results of statistical analysis for its validity and reliability compared to conventional PACS system are reported. Predictive performance of postoperative stone-free rates by IPA measured with the novel method was also evaluated in this study.RESULTS:Bland-Altman plot result shows that there is favorable agreement between IPA values of these two methods. The time required to utilize the PACS was considerably greater than time required to take similar measure using smartphones. The precision-recall curve (PRC) indicates that the new method has similar predictive performance for postoperative clearance rates as PACS.CONCLUSIONS:In summary, measurement of IPA implemented by integrated inclinometer of smartphone is rapid, convenient, accurate and reliable in evaluating renal anatomy parameters of LPC patients.

BackgroundHLRCC-associated RCC (hereditary leiomyomatosis and renal cell cancer-associated renal cell carcinoma) caused by germline mutations of the fumarate hydratase (FH) gene is a rare autosomal dominant genetic renal cancer. At present, there are no reports of bilateral kidneys with HLRCC-associated RCC, let alone safe pregnancy after twice partial nephrectomy for bilateral kidney HLRCC-associated RCC.Case presentationWe report a 25-year-old woman with bilateral renal tumors detected by ultrasound screening during a routine checkup. CT revealed a soft tissue mass in the parenchyma of the left kidney and a nodular soft tissue mass in the lower pole of the right kidney. She underwent robot-assisted laparoscopic left partial nephrectomy and underwent laparoscopic right partial nephrectomy 3 months after the first surgery. Heterozygous mutation in the FH gene on the patient’s tumor tissue was detected by genetic testing. Combined with the patient’s medical history, microstructure and immunohistochemical staining of tumor tissue, and genetic test results, the pathological reports after two operations concluded HLRCC-associated RCC. Then, she was injected with interferon and nivolumab as a preventative treatment against tumor recurrence. Up to 38 months after surgery, having given birth to a baby, till now there was no tumor progression.ConclusionsThis is a clinically significant case, as it provides a reference for pregnancy in patients undergoing partial nephrectomy for bilateral kidneys with HLRCC-associated RCC and may indicate an effective approach to preventing tumor recurrence by nivolumab in patients with HLRCC-associated RCC.

Background Solitary fibrous tumor (SFT) is a relatively rare type of mesenchymal neoplasm that occurs most frequently in the pleura. However, SFT originating from the prostate is particularly uncommon and only approximately 39 cases were reported before. Herein, we reported a rare case of a patient diagnosed with prostate SFT and presented a literature review.Case presentation: A 50-year-old Asian with irritative urinary symptoms was admitted to our hospital and almost all the evidence indicated that benign prostate hyperplasia (BPH) caused his symptoms. Therefore, transurethral resection of the prostate (TURP) was performed, but histopathological and Immunohistochemical (IHC) assessments showed that spindle cells arranged disorderly in the TURP specimen with a cluster of differentiation 34 (CD34), B-cell lymphoma-2 (Bcl-2), and signal transducer and activator of transcription 6 (STAT6) highly expressed and SFT was diagnosed. Finally, the patient underwent a radical prostatectomy and there was no disease progression observed thereafter.Conclusions Prostate SFT is extremely rare, and to our knowledge, this is the first case of prostate SFT that is difficult to differentiate from small volume BPH. IHC examinations are of great diagnostic value. Radical resection of the tumor appears to be the most effective method at present and continuous follow-up is highly recommended.

Abstract To compare the feasibility and effectiveness of gum chewing to promote gastrointestinal (GI) recovery and prevent postoperative ileus (POI) in patients who underwent robot-assisted partial nephrectomy (RALPN), all subjects who met the enrollment criteria were randomly divided into the CG group (n = 23) and the control group (n = 29). No intervention other than chewing gum had been set between the two groups. We took the time of first bowel sound, exhaust, defecation, liquid diet, and solid diet as the study endpoints, and performed statistical analysis between the two groups. Baseline and postoperative data of patients were also recorded and analyzed. The time of first flatus, the first defecation, hospital stay, first liquid diet, and first solid diet in the chewing gum group were significantly shorter than those in the control group (all P < 0.05). CG can be an effective approach to promote bowel function recovery and prevent POI after robot-assisted partial nephrectomy.

目的 比较CT三维重建技术与常规CT检查在嗜铬细胞瘤和副神经节瘤(PPGL)腹腔镜手术规划中的临床效果,探讨CT三维重建技术在PPGL腹腔镜手术规划中的优势.方法 回顾性分析2015年1月至2021年10月该院接受腹腔镜手术且术后病理证实为PPGL的110例患者的临床资料,根据术前是否行CT三维重建评估分为重建组(n=30)和对照组(n=80).比较两组人口学参数、手术时间、术中出血量、术中血流动力学参数、术后并发症、引流管保留时间等情况.结果 与对照组比较,重建组肿瘤操作时收缩压峰值[(132.6±22.1)mm Hg vs.(149.1±21.6)mm Hg]、术中收缩压波动幅度[(38.6±26.9)mm Hg vs.(57.2±28.7)mm Hg]、术中舒张压波动幅度[(22.4±13.2)mm Hg vs.(30.9±12.7)mm Hg]、术中最高心率[(92.4±18.7)次/分钟 vs.(104.4±19.8)次/分钟]、术中心率波动幅度[(29.9±15.6)次/分钟 vs.(42.7±18.0)次/分钟]更小,差异有统计学意义(P＜0.05).结论 CT三维重建技术有助于减小术中血压和心率波动,提高手术安全性.

BACKGROUND:Several groups proved kidney-sparing surgery (KSS) had equivalent oncological outcomes compared with radical nephroureterectomy (RNU) for the low-risk upper urinary tract urothelial carcinoma (UTUC) patients. Whereas, the clinical efficacy of KSS for high-risk UTUC, especially for distal high-risk ureteral carcinoma, remains unclear. OBJECTIVE:To evaluate the feasibility of KSS for patients with distal high-risk ureter cancer. MATERIALS AND METHODS:Our study included 22 patients who diagnose the distal high-risk ureter cancer and underwent KSS between May 2012 and July 2021 in the First Affiliated Hospital of Chongqing Medical University. Overall survival (OS), confirmed as the primary endpoint of present study, was assessed by a blinded independent review committee (BIRC). The secondary endpoints included the postoperative SF-36 (the short form 36 health survey questionnaire) score, progression-free survival (PFS), postoperative complications, and so on. RESULTS:Overall, 17 (77.3%) and 5 (22.7%) patients underwent segmental ureterectomy (SU) and endoscopic ablation (EA), respectively. By the cut-off date, the mean OS was 76.3 months (95% Cl: 51.3-101.1 months) and the mean PFS was 47.0 months (95% Cl: 31.1-62.8 months), respectively. And the SF-36 score in a majority of patients was >300 (90.9%). CONCLUSION:This is a daring endeavor to explore the clinical efficacy of KSS in distal high-risk ureter cancer based on the high-risk UTUC criteria, which shows satisfactory results in the long-term prognosis and operation-associated outcomes. However, future randomized or prospective multicenter studies are necessary to validate our conclusions.