INTRODUCTION:To investigate the feasibility of mini-percutaneous nephrolithotomy (mPCNL) with gravity-assisted low-pressure irrigation in managing renal pelvic stones complicated by multiple calyceal pyonephrosis (characterized by the "cat's paw sign" on CT scan) as an alternative to multiple percutaneous drainage. METHODS:A retrospective analysis was conducted on 7 patients (4 males, 3 females; mean age 52.1 years) who underwent one-stage mPCNL between 2019 and 2023. Meticulous preoperative antibiotic prophylaxis was administered, and intraoperative perfusion pressure was maintained below 100 cm H2O using gravity irrigation. RESULTS:All operations were completed successfully without major complications (Clavien-Dindo grade >2). Two patients experienced transient fever, which resolved with targeted treatment. Key outcomes included stable preoperative hemoglobin levels (mean: 107.86 g/L) and manageable postoperative inflammatory markers (CRP: 35.54 mg/L at 12 h postoperatively). CONCLUSIONS:mPCNL combined with gravity-assisted low-pressure irrigation is a practical alternative for resource-limited centers, enabling single-tract decompression of all obstructed calyces, immediate stone clearance, and acceptable complications. It is particularly suited for small renal pelves with obstructing stones, providing prompt relief of obstruction and infection while minimizing renal parenchymal damage. However, as a pilot study, the small sample size warrants further multicenter studies for validation.

To determine whether omitting routine indwelling catheterization after ureteroscopic lithotripsy reduces postoperative lower urinary tract symptoms and enhances patient comfort, without compromising safety. In this prospective, multicenter, randomized controlled trial, 180 patients undergoing ureteroscopic lithotripsy from August 2024 to June 2025 at four centers were allocated to either the No-Catheter group (n = 91) or the Catheter group (n = 89). The primary outcome was the incidence of lower urinary tract symptoms (LUTS) evaluated by the Patient Perception of Intensity of Urgency Scale and the Visual Analog Scale for pain at 1 h, 4 h, 1 day postoperatively. Secondary outcomes included complications (fever and urinary retention) and distressing memories assessed at a 1-month follow-up using the Subjective Units of Distress Scale. The No-Catheter group had significantly lower LUTS incidence at day 1 (9.9

Following the publication of the above article, a concerned reader drew to the Editor's attention that certain of the immunohistochemical data shown in Fig. 1C on p. 236, and immunofluorescence data featured in Figs. 2G and 5G on p. 237 and 239 respectively, were strikingly similar to data that had appeared in other articles written by different authors at different research institutes which had already been published.  In view of the fact that certain of the data in the above article had already been published at the time of the paper's submission, the Editor of International Journal of Oncology has decided that this paper should be retracted from the publication. After having been in contact with the authors, they accepted the decision to retract the paper. The Editor apologizes to the readership for any inconvenience caused. [International Journal of Oncology 56: 232‑242, 2020; DOI: 10.3892/ijo.2019.4922].

Objective: To explore the efficacy, safety, and feasibility of holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts.Methods: From September 2012 to February 2019, a total of 18 patients, aged from 28 to 62 (mean+standard deviation [SD]: 46.50+9.14) years, were diagnosed with parapelvic renal cysts and treated by holmium laser flexible ureteroscopic intrapelvic drainage. There were 10 males and eight females. All of the parapelvic renal cysts were unilateral, and two cases were complicated with pyelolithiasis. The diameters of the cysts ranged from 4.1 cm to 8.2 cm.Results: All the patients completed the operation successfully in one stage without conversion to open surgery; in two cases, it was difficult to find the cysts during the operation, and the localization was completed by B-ultrasound and percutaneous injection of methylene blue. The mean operative time was 33.89 (SD: 9.68; range: 22-54) min, and the mean hospitaliza-tion time was 2.67 (SD: 0.91; range: 2-5) days. Three months and 6 months of follow-up were performed after surgery. The cysts disappeared in 13 (72%) cases, and the diameter of the cysts in five (28%) cases decreased by more than 50%.Conclusion: Holmium laser flexible ureteroscopic intrapelvic drainage in the treatment of parapelvic renal cysts is simple, safe, and effective, and can be used as the first choice for the treatment of parapelvic renal cysts.(c) 2023 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/ licenses/by-nc-nd/4.0/).

During the postoperative management of urinary diseases, oral or intravenous administration of drugs and implanting ureteral stents are usually required, making localized drug delivery by ureteral stent a precise and effective medication strategy. In the traditional drug loading method, the drug was premixed in the implants in production lines and the versatility of drugs was restricted. However, the complex situation in the urinary system fails the possibility of finding a “one fits all” medication plan, and the intraoperative drug-loading of implants is highly desired to support customized therapy. Here, we designed an ultrathin (8 μm), elastic, and self-adhesive nanofiber bio-tape (NFBT) that can easily encapsulate drugs on the stent surface for controllable localized drug delivery. The NFBT exhibited high binding strength to a ureteral stent, a sustained release over 7 d in PBS for hydrophilic drug, and a zero-order release curve over 28 days for the hydrophobic drug nitrofurantoin (NFT). Further in vivo experiments using a porcine ureteral tract infection model demonstrated that NFBT loaded with NFT could significantly reduce the bacterial concentration in urine. The total amount of NFT delivered by the NFBT was about 2.68 wt% of the recommended dose for the systemic administration.

Objective: In second-stage percutaneous nephrolithotomy (PCNL), because the hydronephrosis has been decompressed, the dilated renal pelvis has resolved and the space is small. Consequently, introduction of the tip of the Amplatz dilator can cause injury to the opposite side of the renal-pelvic mucosa. In this study, we report the experimental and initial clinical performance of a spherical-headed fascial dilator developed specifically for second-stage PCNL. Methods: The novel spherical-headed dilator was compared with existing tapered-headed dilators in configuration and in puncture resistance utilizing a static puncture test. Subsequently, a pilot clinical study was conducted during which patients scheduled to undergo second-stage PCNL from June 2019 to October 2019 in our center were enrolled. A typical ultrasound guided PCNL procedure was performed with the exception that the new spherical-headed fascial dilator was substituted for a tapered-headed one. Results: Experimentally, stab resistance against polyethylene film was significantly increased using the novel spherical-headed dilator compared to the traditional tapered-headed dilators (p<0.005). In the clinical study, the novel dilators were successfully introduced into the renal pelvis and passed down the collecting system in all eight second-stage PCNL cases. There were no cases of renal pelvic perforation or brisk hemorrhage nor need for transfusion. Conclusion: The design of the novel spherical-headed fascial dilator avoided the concentration of pressure at the tapered tip of the current Amplatz dilator by increasing the contact area and uniformly distributing and diffusing the pressure. Therefore, it is feasible to use the spherical-headed fascial dilator for second-stage PCNL. (C) 2021 Editorial Office of Asian Journal of Urology. Production and hosting by Elsevier B.V.

The biofouling of ureteral stents and subsequent urinary tract infections mainly come from the adsorption and adhesion of proteins and microorganisms and their ensuing proliferation. Although general polycationic surfaces in implants have good antibacterial activities, they suffer from limited durability due to severe protein and bacterial adsorption. Here, a biodegradable and anti-biofilm fiber-membrane structured ureteral stent (FMBUS) with synergetic contact-killing antibacterial activity and antiprotein adsorption is described. The stent is prepared by generating hyperbranched poly(amide-amine)-grafted polydopamine microparticles (≈300 nm) on the surface of fibers by in situ polymerization and Schiff base reactions. The biomimetic surface endows the FMBUS with a positive charge (+21.36 mV) and superhydrophilicity (water contact angle: 0°). As a result, the stents fulfilled the following functions: i) reduced attachment of host protein due to superhydrophilicity (Lysozyme: 92.1%; human serum albumin: 39.4%); ii) high bactericidal activities against contact pathogenic bacteria (contact-killing rate: 99.9999% for both E. coli and S. aureus; antiadhesion rate: 99.2% for E. coli and 99.9999% for S. aureus); iii) biocompatibility in vitro (relative growth rate of L929: >90% on day 3) and in vivo; and iv) gradient biodegradability to avoid a second surgery of stent extraction 1-2 weeks after implantation.

Forgotten ureteral stents (FUS) is a great threat to both patients and doctors. Applications on smartphones can significantly reduce the incidence of FUS. But existing applications do not have instant notification and consultation functions. To implement those function, we developed a ureteral stent tracking system embedded in a social networking service application, WeChat. “Ureteral Stent Tracking System” was developed on WeChat, a social media application using by 1.4 million active users. The study consecutively enrolled patients who underwent ureteral stent installation from April 2018 to July 2018. Each patient’s information was recorded on the smartphone by the urologists to create a document immediately after the surgery. The system sends notifications twice a week to both patients and clinicians via the message function of WeChat. A total of 183 patients were enrolled. The most senior patient enrolled was 73 years old. 156 (85.2%) patients underwent stent extraction before the scheduled time. 22 did not undergo stent extraction before the scheduled time because of urinary tract infection or stone residue. They underwent stent extraction within 1 month after the scheduled time. Two patients did not come to the hospital until we had made a phone call to them, though they had received notification from the online system. During the study, no patient was lost-to-follow up. In bilateral stents cases, no stent was forgotten after extraction surgery. A total of 85 (46.4%) patients consulted 132 issues in the system. 52 (39.4%) patients complained about hematuria. 36 (27.3%) patients reported lower urinary tract symptoms. All the consultations were answered within 24 h. “Ureteral Stent Tracking System” implement instant notification and consultation functions via WeChat. It helps urologists to manage indwelling ureteral stents and to reduce the incidence of FUS efficiently.

Urinary tract infections (UTIs) caused by the contamination of the ureteral stent and the pain associated with secondary stent extractions are worldwide problems in the treatment of urinary tract disorders. Here, we reported a biodegradable, long-term antibacterial, and extraction-free ureteral stent with a constantly renewable contact-killing surface and an antibiofilm function achieved by constructing a hyperbranched poly(amide-amine)-capped Ag shell and Au core nanoparticle (Ag@Au NP)-embedded fiber membrane-structured poly(glycolic acid)/poly(lactic-co-glycolic acid) (PGA/PGLA) ureteral stent. The ureteral stent showed fast contact-killing properties, i.e., 5 min for Escherichia coli and 10 min for Staphylococcus aureus, with an inhibition rate higher than 99%. In addition, gradient degradation of PGA/PGLA endowed the stent with a self-cleaning property and long-term antibacterial function by continuous exfoliation of the stent surface, thereby exposing the inner Ag@Au NPs and eliminating adherent bacteria and proteins. Subsequently, in the 16-day in vitro degradation test, the stent showed durable bactericidal activity, less total release of Ag and Au elements (6.7%, similar to 8 mu g), and low cytotoxicity (with a relative growth rate of >80% of L929 cells). In vivo experiments on a farm pig model showed that the stent exhibited a remarkable antibiofilm property and reduced the level of inflammatory and necrotic cells. After seven days of implantation, the stent showed a gradient degradation behavior and maintained structural integrity without the presence of any large fragments in the urinary system according to the B-ultrasonic examination. The as-developed biodegradable and renewable contact-killing antibacterial strategy was efficient in preparing the ureteral stent with antibiofilm and extraction-free properties to treat stent-induced UTI. Statement of significance This study presents a customized antibiofilm solution for biodegradable implants. Two particularly important aspects of this work are as follows: (1) The ureteral stent showed functions of bacterial inactivation and removal of dead bacterial debris. It can continuously exfoliate the stent surface, expose internal antibacterial agents, and remove adherent bacteria and proteins. The stent exhibited a remarkable antibiofilm property and reduced the level of inflammatory and necrotic cells after three weeks of implantation. (2) The antibacterial agents were firmly attached to the degrading matrix by hydrogen bonding, thereby resulting in long-term bactericidal activity, low total release of the antibacterial agent (6.7%, similar to 8 mu g), and low cytotoxicity (with a relative growth rate of >80% of L929 cells). (C) 2020 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

男科手术学起步晚但发展迅速,男科手术既包括治疗隐匿性阴茎、阴茎硬结症和精索静脉曲张结扎显微外科等常见手术,也包括治疗阴茎勃起功能障碍的阴茎假体植入术,以及需要显微技术和皮瓣技术相结合的阴茎再造、阴茎移植等复杂手术.男科手术总体上向着精细化和规范化的方向发展,根据长期随访结果进行不断地改善以改良手术方式和提高手术技巧.本文通过介绍男科手术的新进展,旨在为男科同仁提供诊治新思路.

Yes-associated protein 1 (YAP1) and mammalian target of rapamycin (mTOR) signaling pathways have been found to be deregulated in bladder cancer and accelerate the malignant progression of bladder cancer. However, the cross-talk between YAP1 and mTOR and its role in bladder cancer progression remains unclear. The aim of the present study was to investigate this crosstalk and the results revealed that the expression of YAP1 and mTOR was elevated in bladder cancer tissues compared with that in adjacent normal tissues. Knockdown of either mTOR or YAP1 with siRNA transfection significantly repressed the proliferation ability and induced apoptosis of HT-1376 and J82 bladder cancer cells, particularly when YAP1 and mTOR were downregulated simultaneously. Upregulation of mTOR increased the mRNA and protein levels of YAP1 and enhanced its nuclear accumulation. In turn, YAP1 upregulation increased mTOR expression, reduced its protein degradation and increased its stability. In addition, immuno-fluorescence and Duolink assays demonstrated that YAP1 and mTOR were co-localized in the nucleus. Immunoprecipitation assay demonstrated that the YAP1 protein was able to bind to the mTOR protein. Moreover, YAP1 combined with S-phase kinase-associated protein 2 (SKP2) and positively regulated its expression. Furthermore, the promotion of cell growth and inhibition of cell apoptosis induced by YAP1 overexpression were abolished when SKP2 was downregulated in HT-1376 and J82 cells. Taken together, the findings of the present study indicated that the crosstalk between YAP1 and mTOR plays a pivotal role in accelerating the progression of bladder cancer, which may provide new insights into the role of the YAP1/mTOR axis in the occurrence and development of bladder cancer.

Prostate cancer is the second leading cause of death in USA and has developed serious resistance to current drugs. Thus, development of new drugs for the treatment of castration-resistant prostate cancer (CRPC) is urgently needed. In this study, 25 novel derivatives of tanshinone IIA as potential androgen receptor (AR) suppression reagents for the treatment of CRPC have been synthesized. The inhibition on DHT-mediated AR transactivation and cell viability assay were performed to test the synthesized compounds. The results showed that among 25 new compounds, seven methoxy-substituted tanshinone IIA derivatives showed significant inhibition effect on DHT-mediated AR transactivation. In particular, TAN-24 that contains three methoxy groups showed the strongest inhibition effect on DHT-mediated AR transactivation. In addition, TAN-24 also suppressed DHT-AR transactivation more effectively than those of tanshinoneIIA and enzalutamide. In cytotoxicity against human prostate cancer cell lines assay, TAN-24 exhibited the most potent in vitro cytotoxicity against LNCaP and CWR22Rv1 cells, with IC50 values 20- and 19-times lower than those of tanshinone IIA and comparable to enzalutamide. TAN-24 reported in the present work represents a novel and effective AR suppression drug, showing great potential for the treatment of CRPC.

体外冲击波碎石术(extracoporeal shock wave lithotripsy,ESWL)是临床上治疗泌尿系结石的常用方法,已在国内外广泛应用数十年,具有操作简便、定位准确、疗效确切、安全性高等优点.近年来,随着腔道内镜和微创外科技术的迅速发展,输尿管镜碎石术和经皮肾镜碎石术的应用率逐渐增加,但ESWL仍是泌尿系结石最主要的治疗方法之一.本文概要介绍ESWL治疗泌尿系结石的现状及技术发展.

Kaempferol is a well-known natural flavonol reported to be a potential treatment for multiple cancers. In this study, we demonstrated that cell growth of androgen-sensitive LNCaP cells could be inhibited 33% by 5 μM kaempferol, around 60% by 10 μM kaempferol, and almost 100% by 15 μM kaempferol. Also, kaempferol showed relatively limited effect on PC-3 cells and nonmalignant RWPE-1 cells. In the presence of DHT, the IC50 for kaempferol was 28.8±1.5 μM in LNCaP cells, 58.3±3.5 μM in PC-3 cells, and 69.1±1.2 μM in RWPE-1 cells, respectively. Kaempferol promotes apoptosis of LNCaP cells in a dose-dependent manner in the presence of dihydrotestosterone (DHT). Then, luciferase assay data showed that kaempferol could inhibit the activation of androgen receptors induced by DHT significantly. The downstream targets of androgen receptors, such as PSA, TMPRSS2, and TMEPA1, were found decreased in the presence of kaempferol in qPCR data. It was then confirmed that the protein level of PSA was decreased. Kaempferol inhibits AR protein expression and nuclear accumulation. Kaempferol suppressed vasculogenic mimicry of PC-3 cells in an in vitro study. In conclusion, kaempferol is a promising therapeutic candidate for treatment of prostate cancer, where the androgen signaling pathway as well as vasculogenic mimicry are involved.

目的 观察中医导引排石操联合周氏排石汤(药操联合疗法)治疗湿热下注型上尿路结石的临床疗效.方法 将158例湿热下注型上尿路结石患者随机分为治疗组和对照组,每组79例.治疗组予周氏排石汤联合中医导引排石操(药操联合),对照组予周氏排石汤治疗.两组疗程均为1个月,观察临床疗效及用药安全性,比较中医证候积分及各症状评分的变化情况.结果 ①最终150例患者完成研究,治疗组75例,对照组75例.②治疗组、对照组总有效率分别为68.0％、60.0％;组间临床疗效比较,治疗组明显优于对照组(P＜0.05).③治疗前后组内比较,两组中医证候总积分及各症状评分比较,差异均有统计学意义(P＜0.05).组间治疗后比较,治疗组中医证候总积分明显低于对照组(P＜0.05);治疗组尿道灼热、尿频、尿急评分明显低于对照组(P＜0.05),而腰痛、血尿、尿痛、少腹拘急评分组间差异无统计学意义(P＞0.05).结论 中医导引排石操联合周氏排石汤(药操联合疗法)治疗湿热下注型上尿路结石,安全有效,疗效优于单纯中药治疗,可明显改善临床症状,促进结石排出,减轻患者痛苦.

Artificial conduits, including ureteral stents and catheters, are used widely as drainage tools in the urinary system. However, various bacteria in the urine and long duration of insertion can arouse the biofilm formation on the pipeline surface, which calls for effective antibacterial strategy. In this article, the mechanism of Catheter Associated Urinary Tract Infections (CAUTI) is explained from the perspective of etiology. Then, the biofilm formation conditions and the features of urine are analyzed, the antibacterial agents and approaches suitable for ureteral stents and catheters are introduced and their pros and cons are discussed respectively.

Background and Objective: The aim is to study the efficacy and safety of flexible ureteroscopic lithotripsy (fURSL) for renal stone with persistent urinary tract infection (UTI). Materials and Methods: We retrospectively included 15 cases of patients diagnosed with renal stone together with persistent UTI, who were treated with fURSL from October 2011 to June 2015. A group of 15 patients diagnosed with renal stone, without any sign of persistent UTI, were set as control group. Standard fURSLs were performed by two experienced urologists. Vital signs, routine blood test and kidney, urine, and bladder were observed as well. The double J stent was removed 2–4 weeks after the operation. Results: All operations were done in one-stage. In UTI group, the average operation time was 30 ± 21 min (15–50 min). The stone-free rate (SFR) was 93.3% (14/15). Two cases (13.3%) of fever were observed after the operation, all happened within 6 h postoperatively, with the highest temperature of 39°C. All patients were cured with antibiotics. Conclusions: It is safe to perform fURSL on renal stone patients with persistent UTI under the protection of sensitive antibiotics. The SFR and postoperative complications were acceptable. Low-pressure irrigation and careful postoperative observation are of great importance for these patients.

Abstract Background: Unilateral renal tumor cryoablation and contralateral radical nephrectomy of bilateral renal tumors were performed by transumbilical three-dimensional (3D) multichannel laparoendoscopic single-site (LESS) surgery, in an attempt to verify the feasibility and safety of the procedure, sum up the operational experience, and evaluate the surgical outcome. Case Presentation: This was a 47-year-old female patient with a body mass index of 27.34 kg/m2 without backache, low back pain, hematuria, urinary urgency, frequent urination, dysuria, and other symptoms. Contrast-enhanced CT scan of the kidney on admission showed four masses in the left kidney and two masses in the right kidney. Preoperative serum creatinine (SCr) was 87 μmol/L. Operation was performed under general anesthesia by first laying the patient in a left lateral position. A 2-cm longitudinal transumbilical skin incision was made to expose the right kidney for complete dissection of the two tumors. First, puncture biopsy was performed, and then two freeze–thaw cryoablation cycles for the two tumors were performed. At last, the patient was laid in a right lateral position for radical nephrectomy of the left kidney. The operative duration, cryoablation time, and estimated blood loss were 200 minutes, 40 minutes, and 100 mL, respectively. Postoperative pathological examination revealed clear-cell renal cell carcinoma. The right glomerular filtration rate tested was 42.36 mL/minute and SCr was 131 μmol/L at day 5 after surgery. There was no evidence of contrast enhancement at the cryoablative region as shown by renal contrasted CT scan performed 4 days after surgery and renal contrasted MRI scan performed 6 weeks after surgery, indicating that there was no tumor remnant or recurrence. Conclusion: Our preliminary experience shows that the treatment of bilateral renal tumors with unilateral renal tumor cryoablation and contralateral radical nephrectomy by transumbilical 3D LESS is safe, feasible, and effective. It may prove to be a viable option for patients with significant comorbidities and an insensitive treatment intention.

Curcumin was recently discovered to strengthen immune response through multiple mechanisms. Cytotoxic CD8+ T-cells play a critical role in modulating anticancer immune response, but is severely restricted by T-cell exhaustion. Bladder carcinomas express PD-L1 and can abrogate CD8+ T-cell response. Thus, we hypothesized that bisdemethoxycurcumin, a natural dimethoxy derivative of curcumin, may provide a favorable environment for T-cell response against bladder cancer when used in combination with α-PD-L1 antibody. Immunocompetent C56BL/6 mouse models bearing subcutaneous or lung metastasized MB79 bladder cancer were established to validate this conjecture. We found that bisdemethoxycurcumin significantly increased intratumoral CD8+ T-cell infiltration, elevated the level of IFN-γ in the blood, and decreased the number of intratumoral myeloid-derived suppressor cells. Furthermore, α-PD-L1 antibody protected these amplified CD8+ T-cells from exhaustion, and therefore facilitated the secretion of IFN-γ, granzyme B, and perforin through these CD8+ T-cells. As a result, this combination treatment strategy significantly prolonged survival of intraperitoneal metastasized bladder cancer bearing mice, suggesting that bisdemethoxycurcumin in combination with α-PD-L1 antibody may be promising for bladder cancer patients.