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Biopsy-free, stitchless, clipless radical prostatectomy

Journal of Modern Urology.2024;29(10):848-851. doi:10.3969/j.issn.1009-8291.2024.10.002

Biopsy, intraoperative suturing of the dorsal vascular complex (DVC) of penile and clipping of the lateral vascular pedicle to control bleeding during radical prostatectomy (RP) are the classic procedures for the diagnosis and treatment of prostate cancer in clinical practice. Based on intrafascial RP and the idea of whole gland conformal separation, a series of "micro-innovations" were carried out, including DVC stitchless and vascular pedicle clipless techniques. They simplified the surgical steps, protected the surrounding structure and facilitated RP, which were preferred for patients with localized prostate cancer.

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COUB: a new syndrome of lower urinary tract symptom

Zhiming BAI

Journal of Modern Urology.2024;29(10):852-854. doi:10.3969/j.issn.1009-8291.2024.10.003

Comprehending coexisting overactive-underactive bladder (COUB) contributes to the exploration of lower urinary tract symptom (LUTS). This article reviews the definition, possible pathophysiological mechanisms, symptoms and diagnosis, as well as treatment options of COUB, so as to enhance the classification, diagnosis, and treatment of lower urinary tract symptom.

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Effects of voiding positions on uroflowmetry parameters and post voided residual in young men

Songyang WANG ; Feng SI ; Jianguo WEN ; Yakai LIU ; Maochuan FAN ; Huiqing ZHANG

Journal of Modern Urology.2024;29(10):855-858. doi:10.3969/j.issn.1009-8291.2024.10.004

[Objective] To investigate the impacts of voiding positions on urinary flow measurement (UFM) and post voided residual (PVR) in young males, to explore a better voiding position, and to provide reference for the clinical application of UFM. [Methods] A total of 43 male medical students (22-28 years old, all healthy with no lower urinary tract symptoms) from the First Affiliated Hospital of Xinxiang Medical College were enrolled.UFM was recorded in standing position, forward-bentding sitting position and sitting position, respectively.PVR was determined with B-ultrasound immediately after each voiding.Voided volume (VV), maximum urine flow rate (Qmax), average urine flow rate (Qave) and PVR were compared. [Results] In the standing, forward-bending sitting, and seating positions the VV were 211.6 (169.5, 265.9) mL, 206.8 (173.5, 262.8) mL, and 203.7 (175.9, 260.0) mL, respectively, with no significant difference (P=0.486); the Qmax were (26.00±2.33) mL/s, (26.41±2.12) mL/s, and (23.50±2.52) mL/s, respectively; the Qave were (14.03±2.21) mL/s, (14.27±2.18) mL/s, and (11.77±1.89) mL/s, respectively; the PVR were (9.97±2.26) mL, (9.43±1.97) mL and (12.10±3.28) mL, respectively.The Qmax and Qave in standing position and forward-bending sitting position were significantly higher than those in the sitting position, while the PVR was lower than that in the sitting position, with statistically significant difference (P<0.05). There were no significant differences in Qmax, Qave and PVR between the forward-bending sitting and standing positions (P>0.05). [Conclusion] Standing position and forward-bending seating position are beneficial for emptying the bladder, and these two positions are recommended for young men to urinate as the first choice.

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Efficacy of FURL with FV-UAS for 2-3 cm upper urinary tract stones

Qinglai TANG ; Dujian WANG ; Fade LIU ; Xingzhu ZHOU ; Rongzhen TAO

Journal of Modern Urology.2024;29(10):859-864. doi:10.3969/j.issn.1009-8291.2024.10.005

[Objective] To explore the efficacy of disposable flexible ureteroscopic lithotripsy (FURL) with flexible vacuum-assisted ureteral access sheath (FV-UAS) in the treatment of 2-3 cm upper urinary tract stones, so as to provide reference for the treatment selection. [Methods] Clinical data of 178 patients with upper urinary tract stones who received FURL or minimally invasive percutaneous nephrolithotomy (MPCNL) at our hospital during Apr. 2022 and Oct. 2023 were retrospectively analyzed. The patients were divided into FV-UAS group (n=90, received FV-UAS combined with diaposable FURL treatment) and MPCNL group (n=88, received MPCNL). The general information, perioperative data, and postoperative stone-free rate (SFR) of the two groups were compared. [Results] All operations were successfully completed. The operation time was significantly longer in the FV-UAS group than in the MPCNL group [(66.5±6.7) min vs. (63.9±7.4) min, P=0.015]. However, the intraoperative hemoglobin reduction [(7.3±3.1)g/L vs.(11.4±5.9)g/L], postoperative hospital stay (P<0.001) [(2.2±0.7)d vs.(5.4±1.3)d], and visual analogue score (VAS) [(2.7±0.9)vs.(5.6±1.1)] were significantly lower in the FV-UAS group than in the MPCNL group (P<0.001). The incidence of persistent gross hematuria was significantly higher in the MPCNL group than in the FV-UAS group (12.5% vs. 3.3%, P=0.023). The FV-UAS group had a similar postoperative immediate (83.3%) and final SFR (95.6%) to those of the MPCNL group (89.8%, 96.6%, P>0.05). [Conclusion] The combination of FURL with FV-UAS for 2-3 cm upper urinary tract stones has a higher SFR and a lower complication rate.Patients experience endurable pain and fast recovery, which is worth promoting and applying in clinical practice.

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Analysis of 23 cases of spontaneous perirenal urine extravasation after urinary tract obstruction

Peili MA ; Haitao DAI ; Zhong ZHANG ; Yuanhua LIU ; Peichao GUO ; Zhenxing HU ; Changwei PENG

Journal of Modern Urology.2024;29(10):865-868. doi:10.3969/j.issn.1009-8291.2024.10.006

[Objective] To investigate the clinical manifestations and explore the experience of diagnosis and treatment of spontaneous perirenal urine extravasation after urinary tract obstruction so as to improve the understanding of the disease. [Methods] The clinical data of 23 patients with spontaneous perirenal urine extravasation after obstruction treated at our hospital during 2018 and 2020 were retrospectively analyzed, including the primary diseases, clinical manifestations, imaging examination, treatment and prognosis. The key points of diagnosis and treatment were summarized. [Results] Of the 23 patients, there were 15 males and 8 females, with an average age of 43.4 years. These cases were diagnosed by imaging tests such as ultrasound, computed tomography urography (CTU) and CT. Ureteroscopic lithotripsy was performed in 3 patients with ureteral calculi, retrograde ureteral catheterization in 4 patients and percutaneous nephrostomy in 13 patients. Afterwards, a second phase surgery was performed based on the patients' condition. Of the 3 patients with tumor metastasis who underwent retrograde ureteral catheterization, 2 operation were successful, and 1 operation failed and then converted to nephrostomy and drainage under B-ultrasound localization. [Conclusion] CTU should be performed as soon as possible to make a definite diagnosis. Treatment can be achieved with ureteral retrograde catheterization or percutaneous nephrostomy to achieve local decompression, followed by secondary surgery to treat the primary cause of obstruction.

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Correlation between modified frailty index and acute kidney injury after laparoscopic radical nephrectomy in elderly patients

Zesen YU ; Wenju WU ; Donglai LIU ; Renfu CHEN ; Junjie LIU

Journal of Modern Urology.2024;29(10):869-874. doi:10.3969/j.issn.1009-8291.2024.10.007

[Objective] To explore the correlation between the 5-factor modified frailty index (mFI-5) and acute kidney injury (AKI) after laparoscopic radical nephrectomy in elderly patients with renal cancer, so as to provide reference for the prevention and treatment of postoperative AKI. [Methods] A retrospective analysis was conducted on the clinical data of 214 elderly patients (≥60 years) who underwent laparoscopic radical nephrectomy at our hospital during Dec.2018 and Dec.2021.Patients were divided into frail group (n=75, mFI-5≥2) and non-frail group (n=139, mFI-5<2). The incidence of AKI and sub items of mFI-5 were compared between the two groups.According to the occurrence of AKI, patients were divided into AKI group (n=77) and non-AKI group (n=137). Univariate and multivariate logistic analyses were conducted to identify risk factors of AKI.Receiver operating characteristic (ROC) curves were plotted to test the effectiveness of mFI-5 in predicting AKI. [Results] The incidence of AKI was significantly higher in the frail group than in the non-frail group (64.00% vs. 20.86%, P<0.05). Univariate analysis showed that the incidence of AKI was related to gender, diabetes, hypertension, nonfunctional independent status, weakness and split kidney glomerular filtration rate (GFR). Multivariate logistic regression analysis showed that male (OR=2.454, 95%CI: 1.193—5.047), complicated weakness (OR=6.580, 95%CI: 3.380—12.811), and low split kidney GFR (OR=0.945, 95%CI: 0.911—0.980) were independent risk factors of AKI (P<0.05). The area under the ROC curve of AKI predicted by mFI-5 was 0.711. [Conclusion] Preoperative mFI-5 score is an effective predictor of AKI in elderly patients undergoing laparoscopic radical nephrectomy.As patients with frailty have a higher risk of AKI, preoperative evaluation and monitoring should be strengthened and timely intervention should be taken to improve the prognosis.

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A comparative study of RIRS with flexible negative pressure aspiration, RIRS with conventional sheath and PCNL in the treatment of heavy load upper urinary tract stones

Chenglin ZHUANG ; Baojun ZHUANG ; Jizong LYU ; Guanyu WU ; Zhendong MU ; Xin YANG ; Fei LIU ; Wei ZHENG

Journal of Modern Urology.2024;29(10):875-879. doi:10.3969/j.issn.1009-8291.2024.10.008

[Objective] To explore the efficacy and safety of retrograde intrarenal surgery (RIRS) using a flexible negative pressure suction sheath in the treatment of upper urinary tract stones >2 cm in diameter, to provide reference for the diagnosis and treatment of such disease. [Methods] Clinical data of 155 patients who underwent surgery for upper urinary tract stones during Nov.2022 and Nov.2023 at the Second Affiliated Hospital of Shaanxi University of Chinese Medicine were retrospectively analyzed.The patients were divided into 3 groups: percutaneous nephrolithotripsy (PCNL) group (n=54), conventional sheath RIRS group (n=41), and flexible sheath RIRS group (n=60). The general and clinical data of the 3 groups were compared. [Results] The PCNL group had more patients with severe hydronephrosis (22.22% vs. 4.88%, 5.00%, P=0.027) and smaller IPA involving the lower calyx [(36.17±17.6)° vs. (48.57±17.56)°, (47.41±10.82)°, P=0.014] than the conventional sheath RIRS group and flexible sheath RIRS group.Three days after operation, the stone-free rate (SFR) was 90.74%, 53.66% and 78.33% in the PCNL, conventional sheath RIRS, and flexible sheath RIRS groups, respectively (P<0.05). At 1 month postoperatively, the SFR was 92.59%, 73.17%, and 81.67%, with no statistically significant difference between the PCNL and flexible sheath RIRS groups (P>0.05), but was higher than that in the conventional sheath RIRS group (P<0.05). The PCNL group had shorter operation time than the two RIRS groups [(65.22±17.67) min vs. (91.73±20.57) min, (94.38±24.75) min, P<0.001], longer postoperative hospital stay [(5.0(4.0, 7.0) d vs.3.0(2.0, 4.0) d, 3.0(2.0, 4.0) d, P<0.001], greater decrease in hemoglobin level [(18.00±5.78) g/L vs. (5.57±5.16) g/L, (7.42±5.09) g/L, P<0.001], and higher visual analogue scale (VAS) score [(4.83±1.48) min vs. (2.95±1.07) min, (3.05±1.21) min, P<0.001], while there was no difference between the two RIRS groups (P>0.05). The costs were lower in the flexible sheath RIRS group than in the conventional sheath RIRS group but higher than in the PCNL group [(23 311.19±1 341.20)yuan vs.(24 550.49±1 172.51)yuan, (15 351.97±1 101.4)yuan, P<0.001]. The overall incidence of complications was similar among the three groups, but stone street occurred only in the conventional sheath RIRS group. [Conclusion] For the treatment of patients with upper urinary tract stones >2 cm, RIRS has shorter postoperative hospital stay, lower hemoglobin decrease, and lower VAS score compared to PCNL; the early postoperative SFR of flexible sheath RIRS is superior to that of conventional sheath RIRS, and the 1-month SFR is comparable to that of PCNL, with a low incidence of stone street.

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Report of four cases of reninoma and literature review

Xun WU ; Zhihua WANG

Journal of Modern Urology.2024;29(10):880-884. doi:10.3969/j.issn.1009-8291.2024.10.009

[Objective] To explore the efficacy and safety of the surgical resection and differential diagnosis of rare benign tumor, reninoma, so as to provide reference for clinical diagnosis and treatment. [Methods] A retrospective analysis was made on 4 patients with reninoma in Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology combined with the data of previous literatures. [Results] Except for patient 4, who was asymptomatic, the rest of the patients had hypertension and electrolyte imbalance. Patient 1 was admitted to hospital twice with adrenocortical adenoma. No renal mass was found on the first visit, and the right kidney abduction mass was indicated during the re-examination due to persistent hypertension. Patient 2 was misdiagnosed with kidney cancer at the beginning; patient 3 had been neglected due to pregnancy and negative imaging results, and then underwent imaging examination again to show a parenchymal mass in the right kidney due to persistent elevation of hypertension, dizziness and headache. Patient 4 had non-functioning reninoma with no clinical manifestations. Patient 1 underwent left adrenal adenoma resection and right partial nephrectomy successively, and patients 2—4 underwent partial nephrectomy. The postoperative pathological results of all patients showed reninoma. The patients' blood pressure, serum potassium, plasma renin and aldosterone concentrations returned to normal after surgery.Except for patient 3, who was in shock after surgery, the rest recovered well. [Conclusion] Reninoma is a rare benign renal tumor with rapid progression and a high risk of complications.Nephron-sparing surgery has a satisfactory outcome and a good prognosis.

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Development and evaluation of a prediction model for uric acid stones based on CT values, cystatin C and urine pH

Guoshuai HUANG ; Haopeng LIU ; Zeming WU

Journal of Modern Urology.2024;29(10):885-891. doi:10.3969/j.issn.1009-8291.2024.10.010

[Objective] To identify the risk factors associated with uric acid stones, construct a nomogram model for predicting the occurrence of the disease, and evaluate its predictive performance. [Methods] A retrospective analysis was conducted on the general and clinical data of 876 patients who underwent surgical treatment for stones at the Department of Urology, the First Affiliated Hospital of Soochow University, during Jan.2020 and Dec.2022.Based on the analysis results of stone composition, the patients were divided into the uric acid stone group (n=82) and non-uric acid stone group (n=794). All patients were then randomly split into the training group (n=526) and validation group (n=350) in a ratio of 6∶4.The training group underwent LASSO regression, univariate, and multivariate logistic regression analyses to identify predictive factors associated with the occurrence of uric acid stones.Based on the factors, a nomogram model was constructed.The performance of the model was evaluated using the validation group data by comparing it with models from other research centers. [Results] LASSO regression, univariate, and multivariate logistic regression analyses revealed that cystatin C, urine pH, and stone CT values were predictive factors for uric acid stones.The area under the receiver operating characteristic curve (AUC) of the model was 0.968 for the training group and 0.956 for the validation group.Compared to other models, this model showed better predictive performance.The integrated discrimination improvement (IDI) and net reclassification index (NRI) in the training group were 0.420 0(95%CI: 0.328 2-0.511 8), P<0.001, and 0.484 2(95%CI: 0.321 3-0.647 2), P<0.001, respectively.In the validation group, the IDI and NRI were 0.405 9 (95%CI: 0.330 7-0.481 1), P<0.001, and 0.365 3 (95%CI: 0.211 6-0.519 0), P<0.001, respectively. [Conclusion] The nomogram model based on cystatin C, urine pH, and stone CT values can predict the occurrence of uric acid stones more accurately than other models, and can serve as a clinical supportive tool for the treatment and prevention of stone recurrence.

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Establishment of a prediction model for postoperative progression-free survival in patients with renal cell carcinoma

Huafeng LI ; Zhenlong WANG ; Hongyi ZHANG ; Zihe PENG ; Chenyue WANG ; Yao DONG ; Haibin ZHOU

Journal of Modern Urology.2024;29(10):892-897. doi:10.3969/j.issn.1009-8291.2024.10.011

[Objective] To analyze factors influencing the postoperative progression-free survival (PFS) in patients with renal cell carcinoma (RCC), construct a nomogram model for predicting PFS, and compare it with other predictive models. [Methods] A retrospective analysis was conducted on the general and clinical data of 263 RCC patients who underwent surgery at the Department of Urology, the Second Affiliated Hospital of Xi'an Jiaotong University, during Apr.2014 and Nov.2021.Patients were divided into the progression group (n=34) and non-progression group (n=229). The data of the two groups were analyzed to identify prognostic variables associated with PFS, and a nomogram model was constructed.The performance of this model was compared with that of the University of California, Los Angeles Integrated Staging System (UISS) score, tumor staging, tumor size, tumor pathological grade, and tumor necrosis scoring system (SSIGN score), and Leibovich score by plotting receiver operating characteristic (ROC) curve and calculating the area under the curve (AUC). Calibration curve of the nomogram was used to validate the model's performance, and K-fold cross-validation was employed to assess its external validity. [Results] Multivariate Cox regression analysis revealed that age (HR=2.255, 95%CI: 1.032-4.926), T stage (HR=5.766, 95%CI: 2.351-14.142), pathological grade (HR=3.100, 95%CI: 1.445-6.651), and pathological necrosis (HR=2.656, 95%CI: 1.253-5.629) were independent risk factors of PFS (P<0.05). The nomogram model based on these four independent variables had AUCs (95%CI) of 0.750 (0.630-0.870), 0.803 (0.705-0.902), and 0.847 (0.757-0.937) for 1, 3, and 5 years, respectively, which were higher than those of UISS score, SSIGN score, and Leibovich score.The calibration curve of the nomogram showed good consistency between predicted and actual probabilities.In K-fold cross-validation, the average AUCs of the nomogram at 1, 3, and 5 years were 0.761, 0.808, and 0.842, indicating good external validity of the nomogram. [Conclusion] The nomogram based on age, T stage, pathological grade and pathological necrosis can accurately predict the risk of postoperative PFS in RCC patients at 1, 3, and 5 years, which can aid clinicians in the early identification of high-risk progression.

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