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Research advances in robot-assisted partial nephrectomy for complex renal tumors

Journal of Modern Urology.2025;30(11):960-966. doi:10.3969/j.issn.1009-8291.2025.11.009

Robot-assisted partial nephrectomy(RAPN),as a minimally invasive surgical technique,has demonstrated significant advancements in recent years for treating complex renal tumors with precision and safety.This article systematically reviews the technical advantages of RAPN compared to laparoscopic partial nephrectomy(LPN)in terms of shortening the ischemia time and protecting renal function;it elaborates on the expansion of indications,the application of emerging technologies(mixed reality,artificial intelligence,imaging navigation during surgery),and surgical innovations(self-fixation suture technique,zero ischemia technique).The clinical efficacy of RAPN in treating renal hilar tumors,complete endophytic tumors,multifocal tumors,and solitary kidney tumors is also evaluated.RAPN,through technological innovation and multidisciplinary integration,provides a more optimized minimally invasive treatment option for complex renal tumors,but in the future,it is still necessary to optimize the prediction of intraoperative complications and long-term renal function protection strategies.

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The apCAF orchestrates tertiary lymphoid structure formation in clear cell renal cell carcinoma via chemokine networks:a spatial multi-omics research

Qintao GE ; Wenhao XU ; Wei ZHANG ; Anwaier AIHETAIMUJIANG ; Hailiang ZHANG

Journal of Modern Urology.2025;30(11):938-946. doi:10.3969/j.issn.1009-8291.2025.11.006

Objective To investigate the heterogeneous lineage of cancer-associated fibroblast(CAF)in clear cell renal cell carcinoma(ccRCC),and explore the relationship between antigen-presentation carcinoma-associated fibroblast(apCAF)and the spatial distribution and formation potential of tertiary lymphoid structure(TLS).Methods Seven single-cell transcriptomic cohorts(n=88)were integrated,and batch effects were corrected using the Harmony algorithm to identify consistent CAF subpopulations across samples.The spatial transcriptomics(GSE175540,n=24)were combined to analyze the spatial interactions between CAF and TLS.Functional annotation was performed using AUCell,and Wilcoxon test was employed to compare the differences in CAF abundance between the immune-sensitive group and the resistant group.The co-localization of TLS with different chemokines was assessed.Results Nine conserved CAF clusters were defined,which were reproducible across different cohorts.Among them,Fibro 4 served as an antigen-presenting type of apCAF,characterized by high expression of HLA-DRA/CD74,and abundance in the immune-sensitive group;its functions were enriched in T cell activation pathways;it was strongly correlated with TLS,and positioned at the periphery of TLS.Cell co-localization analysis revealed that apCAF could recruit lymphocytes to aggregate and form TLS structures via the CXCL13-CXCR5 and CCL19-CCR7 axes.Conclusion This study first reveals that apCAF drives the formation of TLS in ccRCC through a chemokine network,thereby correlating with the response to immunotherapy.The apCAF-TLS axis provides a new strategy for targeting stromal remodeling in the immune microenvironment,and its combined scoring is expected to serve as a biomarker for predicting the efficacy of immune checkpoint blockade therapy.

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Safety management of targeted-immunotherapy combination for renal cell carcinoma

Hailiang ZHANG ; Dingwei YE ; Anwaier AIHETAIMUJIANG

Journal of Modern Urology.2025;30(11):911-917. doi:10.3969/j.issn.1009-8291.2025.11.001

In recent years,the combined application of targeted-immunotherapy has become a recommended treatment option for advanced renal cell carcinoma in various guidelines.However,although this strategy has significant therapeutic effects and survival advantages,it is associated with a variety of adverse reactions that cannot be ignored.Therefore,how to effectively manage adverse reactions and ensure the treatment safety has become one of the core issues.This article systematically reviews the adverse effects and management strategies,discusses the early identification of adverse reactions,monitoring methods,the design of individualized treatment plans and future development,aiming to provide practical safety management guidance and explore the direction of future development.

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Application of modified HOOD technique in laparoscopic radical prostatectomy

Cheng LIU ; Dian XIA ; Zhiyao XU ; Tao TAO

Journal of Modern Urology.2025;30(11):983-987,1013. doi:10.3969/j.issn.1009-8291.2025.11.012

Objective To explore the clinical value of modified HOOD technique in laparoscopic radical prostatectomy.Methods A retrospective analysis was conducted on the perioperative data of 71 patients who underwent laparoscopic radical prostatectomy performed by the same surgical team during Jul.20,2022 and Dec.20,2024.The patients were divided into the observation group(n=28,modified HOOD resection)and conventional group(n=43,conventional resection).Results The observation group had better urinary continence,with higher immediate continence rate(20％vs.9.3％),shorter drainage tube removal time[4(3-6)d vs.6(3-9)d]and shorter hospital stay[6.5(4-13)d vs.9(5-11)d]compared with the conventional group.There were no statistically significant differences in operation time,intraoperative blood loss,and postoperative pathological staging between the two groups(P＞0.05).Conclusion The modified HOOD technique is safe and feasible in laparoscopic radical prostatectomy,which can effectively improve postoperative urinary continence,promote recovery,and enhance patients'quality of life.

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Research advances in novel PET/CT tracers for the diagnosis and treatment of renal cell carcinoma

Xinji YANG ; Zhanyi ZHANG ; Xiaofei HOU ; Shudong ZHANG

Journal of Modern Urology.2025;30(11):947-954. doi:10.3969/j.issn.1009-8291.2025.11.007

Renal cell carcinoma(RCC)is a highly aggressive malignant tumor,for which traditional 18F-FDG positron emission computed tomography/computed tomography(PET/CT)exhibits insufficient sensitivity in diagnosing primary lesions.This article reviews the recent advances in novel PET/CT tracers for the diagnosis and treatment of RCC,focusing on tracers targeting carbonic anhydrase Ⅸ(CAⅨ),prostate-specific membrane antigen(PSMA),fibroblast activation protein(FAP),somatostatin receptor(SSTR),and C-methionine(c-MET).This article aims to provide reference for the early diagnosis and optimization of treatment strategies for RCC,so as to drive innovations in the field of oncologic imaging.These novel tracers demonstrate significant advantages in improving the sensitivity and specificity of detecting primary and metastatic RCC lesions,as well as in assessing treatment response,thereby addressing the limitations of traditional 18F-FDG PET/CT.Although these novel PET/CT tracers show great potential in the diagnosis and treatment of RCC,their efficacy and safety require further validation through large-scale trials.In the future,the development of multi-target tracers combined with artificial intelligence is expected to achieve precise diagnosis and individualized treatment of RCC.

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Expression of insulin-like growth factor family 2 in bladder cancer and its relationship with survival and prognosis

Yi DING ; Wenbo HUANG ; Zhiyang LIU ; Guangui FENG

Journal of Modern Urology.2025;30(11):975-982. doi:10.3969/j.issn.1009-8291.2025.11.011

Objective To explore the prognostic value and immune effects of insulin-like growth factor family 2(IGFL2)in bladder cancer based on data from TCGA,TIMER2.0 and HPA.Methods Bioinformatics analysis was conducted to analyze the expression of IGFL2 in bladder cancer and its relationship with survival and prognosis of bladder cancer patients.The receiver operating characteristic(ROC)curve and prognostic nomogram were plotted to analyze the diagnostic value of IGFL2 for bladder cancer and its ability to predict the 5-year overall survival rate of patients.IGFL2-related signaling pathways were analyzed with GSEA enrichment.The correlation between IGFL2 expression and immune cells was analyzed based on data from the TIMER database.Results IGFL2 was highly expressed in bladder cancer(P＜0.001).The high expression of IGFL2 was positively correlated with patients'age,pathological stage,histological grade and T stage(all P＜0.05).Patients'with high IGFL2 expression had shorter overall survival and disease-specific survival than those with low IGFL2 expression(all P＜0.05).IGFL2 could be used as an independent prognostic factor for bladder cancer with good diagnostic and predictive value.GSEA enrichment analysis showed that IGFL2 was involved in signaling pathways related to immunity,inflammation and tumor.High IGFL2 expression was positively correlated with the infiltration of most immune cells.Conclusion IGFL2 is highly expressed in bladder cancer and can be a biomarker for the diagnosis and prognosis of this disease.It may become a potential target for immunotherapy.

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Research advances in focal therapy for renal tumors

Shibo JIAN ; Yin HUANG ; Dehong CAO ; Liangren LIU

Journal of Modern Urology.2025;30(11):955-959. doi:10.3969/j.issn.1009-8291.2025.11.008

Focal therapy has emerged as an alternative to surgical treatment for selected renal tumors.The core principle of this approach lies in the local destruction of tumor tissue through physical or chemical means to achieve tumor control.Focal therapy is particularly applicable to patients with tumors ≤4 cm in diameter who are unfit for surgery or anesthesia due to advanced age,comorbidities,solitary kidney,or renal insufficiency,as well as those with recurrent tumors after prior partial nephrectomy.This review summarizes the mechanisms,advantages,limitations,and clinical efficacy of six focal therapy modalities for renal tumors,including radiofrequency ablation,cryoablation,microwave ablation,irreversible electroporation,high-intensity focused ultrasound,and stereotactic ablative radiotherapy.The aim is to provide reference for achieving individualized and precise clinical management.

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Research advances on oncolytic viruses and their vectors for bladder cancer treatment

Zhenxing ZHAI ; Zhiping WANG

Journal of Modern Urology.2025;30(9):727-732. doi:10.3969/j.issn.1009-8291.2025.09.001

Bladder cancer has the characteristics of multiple and easy recurrence after surgery.At present,the main treatment methods include surgery,chemotherapy,radiotherapy,and so on.However,the recurrence rate and metastasis rate are still very high,seriously threatening human health.Oncolytic viruses have become an important part of a comprehensive cancer treatment strategy.Compared with surgery,radiotherapy and chemotherapy,oncolytic virus therapy is more precise and less toxic,which is expected to significantly improve patients' quality of life.However,the therapeutic effects of oncolytic viruses alone are satisfactory.Currently,oncolytic viruses are combined with immunotherapy,chemotherapy or radiotherapy to improve the overall anti-tumor effects.The combination of oncolytic viruses and immunotherapy has a relatively broader prospect.This article reviews the research progress of the clinical application of adenovirus vectors,lentiviral vectors,adeno-associated virus vectors,and oncolytic viruses combined with immunotherapy,chemotherapy,and radiotherapy for bladder cancer.

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Analysis of clinical diagnosis,treatment and prognostic factors in 75 cases of urachal carcinoma

Yong ZHANG ; Lingang CUI ; Penghui YUAN ; Tianyu LYU ; Jiahao CUI ; Zhuo ZHAO ; Qingjun MENG

Journal of Modern Urology.2025;30(9):733-738. doi:10.3969/j.issn.1009-8291.2025.09.002

Objective To explore the diagnosis,treatment and prognostic factors of urachal carcinoma(UrC),aiming to provide reference for the standardized diagnosis and treatment of this disease.Methods A retrospective analysis was conducted on the clinical data of 75 UrC patients confirmed with postoperative pathology treated in our hospital during Mar.2010 and Mar.2023.All patients underwent surgical treatment,and 35 received postoperative chemotherapy.Univariate and multivariate Cox regression analyses were performed to identify independent prognostic factors.Kaplan-Meier curves were adopted to calculate the cumulative survival rates and overall survival(OS).Results Among the 75 patients,the male to female ratio was 2.8∶1 and the mean age was(58.4±2.2)years.Median follow-up was 60 months and median OS was 48 months.The 3-year survival rate was 67.3％and the 5-year survival rate was 38.8％.There were 19 cases(25.3％)of CK7 positive,60 cases(80.0％)of Sheldon stage Ⅲ and above,and 26 cases(34.7％)of postoperative recurrence.CK7 positive(P=0.001),Sheldon staging Ⅲ+Ⅳ(P=0.005)and postoperative recurrence(P=0.003)were independent prognostic factors.Conclusion Urachal carcinoma is a rare malignant tumor in males with occult onset.CK7 positive,Sheldon staging and postoperative recurrence were independent prognostic factors of this disease.

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Is flexible ureteroscopic lithotripsy combined with flexible negative-pressure sheath an appropriate treatment option for patients with 3-4 cm renal calculi?

Xiangyu CHEN ; Chancan LI ; Zhe ZHU ; Chang LU

Journal of Modern Urology.2025;30(9):739-743. doi:10.3969/j.issn.1009-8291.2025.09.003

Objective To explore the efficacy and safety of flexible ureteroscopic lithotripsy(FURL)combined with flexible negative-pressure sheath in treating patients with 3-4 cm renal calculi with CT value＜1100 Hu,and to identify a safe and effective treatment option for patients with such calculi.Methods A retrospective analysis was conducted on the clinical data of 95 patients undergoing surgical treatment at the Department of Urology,the Second People's Hospital of Anhui Province during Jun.2022 and May 2024.The patients were divided into two groups,including 42 in the FURL with flexible negative-pressure sheath group(FURL group),and 53 in the percutaneous nephrolithotomy(PCNL)group.General data,perioperative indicators,and complication rates were compared between the two groups.Results There were no statistically significant differences between the FURL group and PCNL group in stone-free rate(SFR)3 days postoperatively(83.3％vs.88.7％),1 month postoperatively(95.2％vs.92.5％),and 3 months postoperatively(97.6％vs.94.3％),as well as operation time[(77.65±9.05)min vs.(79.10±8.14)min](P＞0.05).The FURL group had shorter hospital stay[(5.98±1.12)days vs.(9.38±1.57)days],lower decrease in hemoglobin level[(3.17±0.85)g/L vs.(4.98±1.72)g/L],lower visual analog scale(V AS)score on postoperative day 1[(2.60±0.63)vs.(3.77±1.09)]and day 3[(2.29±0.99)vs.(2.70±0.89)],lower postoperative white blood cell count[(7.05±1.66)× 109 cells/L vs.(11.24±2.90)× 109 cells/L],lower C-reactive protein level[(25.73±7.57)ng/L vs.(31.14±5.53)ng/L],lower blood urea nitrogen level[(6.12±1.43)mmol/L vs.(9.85±3.07)mmol/L],and lower serum creatinine level[(84.48±11.57)μmol/L vs.(114.43±21.48)μmol/L](all P＜0.001).The total incidence of complications was also lower in the FURL group(4.8％vs.18.9％,P＜0.05).Conclusion FURL combined with flexible negative-pressure sheath can achieve comparable SFR as PCNL without extending operation time,and it can shorten hospital stay,reduce intraoperative blood loss,have little impact on renal function,reduce inflammatory response and decrease the incidence of complications.

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