Objective: To investigate the efficacy and safety of intelligent temperature-pressure-controlled flexible ureteroscopy combined with negative-pressure suction sheath lithotripsy in the treatment of upper urinary tract stones ≤2.5 cm. Methods: The clinical data of 225 patients with ≤2.5 cm upper urinary tract stones treated with this surgical method in our department during Aug. 2023 and Jul. 2024 were retrospectively analyzed. The patients were divided into the dual-control group (n=36) and conventional group (n=189) according to whether or not the intelligent temperature and pressure control device was used during operation. In the dual-control group，the intraoperative temperature and pressure in the renal pelvis were monitored and controlled in real time by the temperature and pressure sensors distributed at the end of the ureteral soft lens. The perioperative parameters，stone-removal rate，complication rate and renal function were compared between the two groups. Results: All operations were successfully completed in both groups. The postoperative procalcitonin (PCT) level [(22.75±5.85) ng/L vs. (29.08±6.60) ng/L，P=0.001]，difference in the white blood cell (WBC) level [(0.24±2.12)×10 cells/L vs. (1.19±2.17)×10 cells/L，P=0.016]，incidence of fever (2.8% vs. 16.9%，P=0.028) and overall complication rate (5.6% vs. 19.6%，P=0.042) were significantly lower in the dual-control group than in the conventional group，while the stone-clearance rate was slightly higher (88.9% vs. 82.5%，P=0.346)，with no significant difference. Conclusion: For upper urinary tract stones ≤2.5 cm，intelligent temperature-pressure-controlled ureteroscopy combined with negative-pressure suction sheath lithotripsy has a satisfactory stone-removal rate and a low rate of complications，which is worthy of clinical promotion.

Objective:To investigate the risk factors for postoperative fever in patients with negative preoperative urine culture undergoing flexible ureteroscopy (fURS), and construct a nomogram prediction model to predict the risk of postoperative fever.Methods:The clinical data of 308 patients who underwent flexible ureteroscopy (fURS) at the Second Affiliated Hospital of Zhengzhou University from January 2019 to March2023, were retrospectively analyzed. Among these patients, there were 235 males and 73 females, with an average age of (46.4±12.1) years old. Additionally, 86 cases had concomitant hypertension, 41 cases had diabetes, and 12 cases had coronary heart disease. A history of urinary stone surgery was present in 57 cases, and 91 cases exhibited severe hydronephrosis. The distribution of stones included 164 cases on the left side and 144 cases on the right side, with 88 cases of renal stones, 124 cases of ureteral stones, and 96 cases of renal-ureteral stones. Among them, 243 cases had ≤2 stones, while 65 cases had >2 stones, with a maximum stone diameter of 12.0 (9.0, 15.0) mm. Urine leukocyte-positive cases were 109, and urine leukocyte-negative cases were 199. Two cases were positive for nitrite, and 308 cases were negative. The occurrence of postoperative fever within 48 hours was recorded, and differences between the fever and non-fever groups were compared. Logistic regression analysis was employed to identify risk factors for post-fURS fever. A nomogram prediction model based on independent risk factors was constructed, and internal validation was conducted using 1 000 bootstrap resamples. The predictive performance of the model was evaluated using receiver operating characteristic (ROC) curves and the area under the curve (AUC). Model stability was assessed using calibration curves.Results:The surgeries for all 308 cases were successfully completed with a median operative time of 60.0 (40.0, 75.0) minutes. Complete stone clearance was achieved in 221 cases. Among them, 14 cases (4.5%) experienced postoperative fever, while 294 cases did not. The fever group had a higher proportion of females [57.1% (8/14) vs. 22.1% (65/294), P=0.007], more cases with comorbid diabetes [50.0% (7/14) vs. 11.6% (34/294), P<0.001], a higher proportion of renal stones [64.3% (9/14) vs. 26.9% (79/294), P=0.022], a lower intraoperative stone clearance rate [42.9% (6/14) vs. 73.1% (215/294), P=0.031], larger stone diameter [15.5 (12.5, 19.3) mm vs. 11.0 (9.0, 15.0) mm, P=0.004], longer operative time [87.5 (58.8, 106.3) min vs. 55.0 (40.0, 75.0) min, P<0.001], higher platelet count [267.0 (225.8, 354.0) ×10 9/L vs. 233.0 (197.8, 272.0) ×10 9/L, P=0.026], lower creatinine levels [67.5 (52.5, 72.3) umol/L vs. 73.0 (62.0, 84.0) umol/L, P=0.026], and a higher platelet lymphocyte ratio [148.8 (118.3, 189.3) vs. 119.5 (93.2, 156.0), P=0.030]. Results of univariate analysis showed that female gender, diabetes, stone location, incomplete stone clearance, maximum stone diameter, operative time, platelet count, creatinine, platelet lymphocyte ratio, and positive nitrite in urine (all P<0.05)were risk factors for postoperative fever. Multivariate regression analysis revealed that female gender ( OR=11.073, 95% CI 1.623-75.521, P=0.014), diabetes ( OR=5.995, 95% CI 1.441-24.952, P=0.014), and operative time ( OR=1.024, 95% CI 1.003-1.046, P=0.024) were independent risk factors for post-fURS fever. The nomogram exhibited excellent predictive performance (AUC=0.866, 95% CI 0.781-0.935), and the calibration curve demonstrated good consistency. Conclusions:Female gender, longer operative time, and diabetes are risk factors for post-fURS fever in patients with preoperative negative urine culture. The nomogram demonstrates excellent predictive performance.

Objective:To compare the differences in the results of 24-hour urine citric acid, oxalic acid, and phosphoric acid detection between thymol and concentrated hydrochloric acid preserved urine.Methods:Urine samples were collected from 50 patients with upper urinary tract stones who were admitted to the Second Affiliated Hospital of Zhengzhou University from July 2023 to August 2023. There were 38 males and 12 females, with the age of (45.52 ± 13.68) years old. On the second day of admission, patients were required to empty their bladders in the morning and collect urine over a 24-hour period. The urine was evenly divided and stored in two sealed plastic containers. In one container, concentrated hydrochloric acid (15 ml, concentration of 6 mmol/L) was added as a preservative, forming the hydrochloric acid group. In the other container, 2 g of thymol was added as a preservative, forming the thymol group. The concentration of oxalic acid, citric acid, and phosphoric acid in urine were measured, and the measurement results were multiplied by the total amount of urine to obtain the final measurement results. The differences in the measurement results of citric acid, oxalic acid, and phosphoric acid between two groups were compared.Results:In the concentrated hydrochloric acid group, the median value of citric acid was 160.87(95.37, 245.61) mg/24h, the median value of oxalic acid was 33.09(26.32, 39.37) mg/24h, and the mean value of phosphoric acid was (731.06 ± 240.62) mg/24h. In the thymol group, the median value of citric acid was 340.40(166.56, 561.77) mg/24h, the median value of oxalic acid was 33.91(26.51, 44.56) mg/24h, and the mean value of phosphoric acid was (759.07 ± 273.23) mg/24h. Compared with the thymol group, the citric acid level in the concentrated hydrochloric acid group was significantly lower ( Z=4.31, P< 0.001), but there was no significant difference in oxalic acid ( Z=0.85, P=0.393) and phosphoric acid ( t=1.65, P=0.106) between the two groups. Conclusions:Compared with thymol, the results of 24 h urine citric acid with concentrated hydrochloric acid as preservative is lower, but there is no significant difference between oxalic acid and phosphoric acid.The use of thymol as a preservative may be more suitable than concentrated hydrochloric acid for the detection of citric acid, oxalic acid and phosphoric acid in 24-hour urine metabolism analysis.

Objective:To investigate the safety and efficacy of one-stage transurethral prostatectomy for prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility.Methods:The clinical data of 35 patients with benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility admitted to The Second Affiliated Hospital of Zhengzhou University from January 2015 to Octorber 2021 were analyzed.The average age was (74.0±7.9) years old. The average volume of prostate was (77.8±44.5)cm 3. The average total prostate specific antigen(tPSA)was(8.9±8.7)ng/ml. The preoperative international prostate symptom score(IPSS) was (19.1±4.3) and the preoperative quality of life score(QOL)was 5(5, 5). All the patients were treated with one-stage transurethral prostatectomy and suprapubic cystostomy. After removing the cystostomy tube, the post-void resident volume(PVR), the maximum urine flow rate(Q max), IPSS, QOL were recorded, and complications were followed up. Successful treatment is defined as the removal of the cystostomy tube without worsening of upper urinary tract hydronephrosis. Results:All the operations were successfully completed. The success rate of treatment was 85.7%(30/35), and the median time to resume spontaneous urination was 4.0(3.3, 4.5) weeks. The average postoperative Q max was (12.6±2.3)ml/s, and the average PVR was(27.7±9.5)ml. The postoperative IPSS was (5.5±2.4), which was significantly improved compared to preoperative( P<0.001). The postoperative QOL score was 1(1, 2) points, which was significantly lower than preoperative( P<0.001). The patients voiding spontaneously were followed up for 3-69 months, and no complications such as urinary retention, recurrent urinary tract infection and hydronephrosis occurred. Conclusions:One-stage transurethral prostatectomy for patients with benign prostatic hyperplasia accompanied by non-neurogenic detrusor acontractility has a high success rate and few complications, which greatly improves the quality of life of patients.

【Objective】 To establish a nomogram model for predicting the risk of positive prostate biopsy in MRI-negative patients, and to perform the internal validation. 【Methods】 We retrospectively analyzed the clinical data of 197 MRI-negative patients who underwent prostate biopsy at our hospital, analyzed the independent predictors of positive prostate biopsy with univariate and multivariate logistic regression analysis, constructed the nomogram model and conducted internal validation. 【Results】 Multivariate logistic regression analysis showed age (P=0.003), digital rectal examination (DRE)(P=0.005), total prostate-specific antigen (tPSA) (P=0.001) and prostate volume (PV)(P<0.001) were independent risk factors of MRI-negative but prostate biopsy-positive results. The nomogram model based on all variables was established. The area under the receiver operating characteristic (ROC) curve (AUC) was 0.862, which was greater than that of tPSA (AUC=0.739), PV(AUC=0.711) and DRE(AUC=0.666) (all P<0.05). The average absolute error of the model was 1.1% after 500 internal resampling, indicating that the prediction of positive prostate biopsy was consistent with the actual situation. 【Conclusion】 The age, DRE, tPSA and PV were independent predictors of positive prostate biopsy in MRI-negative patients. The nomogram model has a good prediction performance.

Objective:To explore the independent influencing factors of Gleason group upgrading (GGU)after radical prostatectomy (RP) of localized prostate cancer based on 2014 International Society of Urologic Pathology (ISUP)grouping system, then establish an effective prediction model.Methods:The study included 48567 patients with localized prostate cancer who underwent radical prostatectomy from the surveillance, epidemiology and end results (SEER) database. The age was (61.1±7.0) years, including 39 014 cases (80.3%), 7 063 cases (14.5%), 2 331 cases (4.8%), and 159 cases (0.3%) of White, Black, Asian or Pacific Islander, American Indian/Alaska Native. PSA<4 ng/ml, 4-10 ng/ml, 11-19 ng/ml, ≥20 ng/ml were 6 545 cases (13.5%), 35 007 cases (72.1%), 5 578 cases (11.5%), 1 437 cases (3.0%) respectively. Percent positive cores (PPC)≥33% were 24 743 cases (50.9%). Gleason group of biopsy specimen: G1 18 971cases (39.1%), G2 18 446 cases (38.0%), G3 7 093 cases (14.6%), G4 4 057 cases (8.4%). Simple random sampling was assigned to the cases, divided them into training cohort and internal validation cohort according to the ratio of 7∶3. 67 patients with localized prostate cancer who treated in The Second Affiliated Hospital of Zhengzhou University during January 2017 to December 2021 were set as external validation cohort. All these cases were Asian with Chinese nationality, age(66.4±10.3) years. PSA<4 ng/ml, 4-10 ng/ml, 11-19 ng/ml, ≥20 ng/ml were 13 cases (19.4%), 32 cases (47.8%)16 cases (23.9%), 6 cases (9.0%) respectively. PPC≥33% were 38 cases (56.7%). Gleason group of biopsy specimen: G1 18 cases (26.9%), G2 23cases (34.3%), G3 12 cases (17.9%), G4 14 cases (20.9%). The independent predictors of GGU were analyzed by logistic regression analysis, and the nomogram for predicting GGU were established. Then, the performance of nomograms was internally and externally validated via area under curve (AUC) and the calibration curve.Results:There were 8 716 cases (25.6%), 3 677 cases (25.2%) and 24 cases (35.8%) with GGU in the training group, internal validation group and external validation group, respectively. Logistic regression showed Gleason group of biopsy specimen (G2: OR=0.164, P<0.01; G3: OR=0.073, P<0.01; G4: OR=0.087, P<0.01), PSA (4-10 ng/ml: OR=1.550, P<0.01; 11-19 ng/ml: OR=2.084, P<0.01; ≥20 ng/ml: OR=2.664, P<0.01), age (60-69 years: OR=1.292, P<0.01; ≥70 years: OR=1.550, P<0.01), PPC (≥33%: OR=1.334, P<0.01) and race (Asian or Pacific Islander: OR=1.266, P<0.01) were independent influencing factors for GGU. The predicting model, was established according to Gleason group of biopsy specimen, PSA, age and PPC. The AUC of the model in the training cohort, the internal validation cohort and the external validation cohort were 0.759, 0.757 and 0.747 respectively. The calibration curves of the three cohorts were close to the ideal line and showed good consistency. Conclusions:Gleason group of biopsy specimen, PSA, age, PPC and race are independent influencing factors for GGU after RP of localized prostate cancer. G. P.A.P. model can effectively predict the risk of GGU after RP of localized prostate cancer.

Objective:To investigate the difference of 24h urinary metabolic abnormalities in patients with different subtypes of calcium oxalate stones.Methods:The clinical data of 120 patients with simple calcium oxalate stones admitted to the Second Affiliated Hospital of Zhengzhou University from March 2018 to May 2020 were retrospectively analyzed.There were 90 males (75.0%) and 30 females (25.0%), with the age of (49.1 ±13.5) years old, and body mass index (BMI) of (24.6 ±3.0) kg/m 2. There were 23 cases of diabetes mellitus (19.2%), 8 cases of coronary heart disease (7.0%), 36 cases of hypertension (30.0%) and 45 cases of gastrointestinal diseases (37.5%). There were 11 cases (9.2%) of low pH, 54 cases (45.0%) of hyperoxaluria, 19 cases (15.8%) of hypercalcemia, 72 cases (60.0%) of hypocitrouria, 3 cases (2.5%) of hyperuricuria, and 18 cases (15.0%) of hyperuricemia. In the 120 patients, 79 underwent ureteral soft lithotripsy, 28 underwent percutaneous nephrolithotomy, and 13 underwent extracorporeal shock wave lithotripsy. The patients were divided into calcium oxalate monohydrate stone group (COM group) and calcium oxalate dihydrate stone group (COD group). The general clinical data and urinary metabolic data of the two groups were compared. Independent risk factors for stone formation of the two groups were analyzed. Results:There were 120 cases in this study, with 90 cases in COM group and 30 cases in COD group. Urinary oxalic acid in COM group and COD group was 41.3 (30.1, 54.2) mg and 34.1 (26.6, 39.9) mg, respectively, and the difference was statistically significant ( P=0.01). The incidence of hyperoxaluria was 52.2% (47 cases) and 23.3% (7 cases), respectively, and the difference was statistically significant ( P<0.01). Urinary calcium in COD group and COM group was 6.8 (6.1, 8.8) mmol and 4.0 (2.3, 5.2) mmol, respectively, and the difference was statistically significant ( P<0.01). The incidence of hypercalcemia was 43.3% (13 cases) and 6.7% (6 cases), respectively, the difference was statistically significant ( P<0.01). The urinary phosphate in COM group and COD group was 2 063.5 (1 688.8, 2 803.2) mg and 1 231.7 (766.7, 1 740.9) mg, respectively, and the difference was statistically significant ( P<0.01). The serum uric acid level in COM group and COD group was (343.0±111.7)μmol/L and (297.6±77.6)μmol/L, respectively, and the difference was statistically significant ( P<0.05). There were no significant differences in term of age, gender, body mass index, diabetes mellitus, coronary heart disease, hypertension, gastrointestinal disease, parathyroid hormone (PTH), hemoglobin, serum creatinine, serum potassium, serum phosphorus, serum calcium, serum sodium, stone load and side between the two groups ( P>0.05). There were no significant differences in urinary sodium, urinary phosphorus, urinary magnesium, urinary citric acid and urinary uric acid levels between the two groups ( P>0.05). Binary Logistic regression analysis showed that hyperoxaluria was an independent risk factor for COM patients ( OR=4.859, P<0.01). Increased urinary phosphoric acid level was an independent risk factor for COM patients ( OR=1.001, P<0.01). Hypercalcemia was an independent risk factor for COD patients ( OR=27.856, P<0.01). Conclusions:COM calculus patients have higher urinary oxalic acid and urinary phosphoric acid levels, and are more likely to have hyperoxaluria. COD calculus patients have higher urinary calcium levels and are more likely to develop hypercalcemia.

Objective:To explore risk factors for the efficacy and complications of surgery for infectious kidney stones.Methods:The clinical data of 75 patients with infection kidney stones from January 2015 to May 2022 were retrospectively analyzed. This group of 75 patients, were 23 to 74 of age, with mean of (49.3±10.4) years old. Among them, 25 were male and 50 were female. The mean diameter of the stones was (5.4±2.7)cm. There were 29 cases of staghorn stones, 25 cases of multiple kidney stones, and 21 cases of single kidney stones. Preoperative renal function measuring by creatinine was 68 (51, 68)μmol/L. Twenty-five patients (33.3%) were combined with comorbidities, including diabetes mellitus, neurogenic bladder, spinal cord injury, cerebrovascular disease, or urinary anatomical malformation. All the patients underwent surgical treatment, including percutaneous nephrolithotomy, flexible ureteroscopy, and combined endoscopy. Postoperatively, urosepsis was diagnosed according to the SOFA score. One month after the operation, CT or KUB were re-examined to evaluate the efficacy of the operation. Multivariate logistic regression was used to analyze the risk factors for surgical efficacy, complications and sepsis.Results:All 75 patients undewent successful surgery. The overall stone clearance rate was 64%, and the single-factor analysis showed that the stone diameter ( P=0.001) and stone type ( P=0.002) were the impacting factors of the surgical efficacy of infectious kidney stone. Multivariate analysis showed that stone type ( OR=2.55, 95% CI 1.00-6.51, P=0.049) was an independent risk factor influencing the efficacy of surgery for infectious kidney stones. A total of 24 cases experienced surgical complications after surgery, including 18 cases of infection, 3 cases of bleeding, and 3 cases of subcapsular hemorrhage, and the complication rate was 32.0%(24/75). Univariate analysis showed that hydronephrosis ( P=0.039), comorbidities ( P=0.009), and preoperative renal function ( P=0.008) were risk factors for postoperative complications of infectious nephrolithiasis, and multivariate analysis showed that comorbidities ( OR=0.21, 95% CI 0.05-0.90, P=0.029) were independent risk factors for postoperative complications. The incidence of postoperative urosepsis was 6.7%, and univariate analysis did not find any risk factors for sepsis. Conclusions:Stone type is a factor that affects the efficacy of surgery for infectious kidney stones, and comorbidities are factors that affect surgical complications.

Objective:To investigate the pathogenic bacteria profiles in preoperative urine bacterial cultures of patients with infected kidney stones and use antibacterial drugs to prevent recurrence.Methods:The data of 79 cases with infected kidney stones admitted to the Second Affiliated Hospital of Zhengzhou University from January 2017 to July 2021 were retrospectively analyzed, among whom 29 (36.7%) were male and 50 (63.3%) were female. The age ranged from 17-75 years, with a median age of 49.0 (40, 55) years. Fifteen cases (19.0%) combined hypertension, 13 cases (16.5%) combined diabetes mellitus, and 3 cases (3.8%) combined with cardiovascular disease. Fifty-one cases (64.6%) were diagnosed with cast infectious stones. All patients underwent surgical lithotripsy, and postoperative review of the urological computerized tomography (CT) revealed no residual stones defined as complete lithotripsy, and postoperative oral medication was continued to control infection and prevent stone recurrence. According to post-hospitalization compliance, patients were divided into high and low compliance groups. The high compliance group consisted of patients who returned to the hospital regularly for routine urinalysis and urine bacterial culture after discharge, followed the doctor's prescription for standardized antibacterial drug therapy, and complied with urease inhibitor therapy for ≥6 months. The low compliance group included patients who did not take sensitive antimicrobial drugs regularly and/or were unable to adhere to the medication even after the reduction of vinblastine due to adverse events such as tremor, palpitations, headache, anemia, or gastrointestinal discomfort. The recurrence of stones at 3, 6 and 12 months of follow-up was compared between the two groups.Results:Of the 79 cases in this group, 56(70.9%) were completely clear of stone after surgery. Thirty-three cases (41.8%) presented positive in preoperative urine bacterial culture, and the most common causative organism was Aspergillus oddus in 17 cases (21.5%), followed by Escherichia coli in 8 cases (10.1%) and Klebsiella pneumoniae in 3 cases (3.8%). Among the 17 positive cases of A. oddis, six were positive for ultra broad spectrum β-lactamases (ESBLs), 6/6 were resistant to ampicillin, cefazolin, and cotrimoxazole, 1/6 were resistant to amikacin, cefoxitin, and ticarcillin/stick acid, and none were resistant to imipenem, polymyxin, or aminotrans (0/6 cases). Of the cases, 11 were negative for ESBLs. Ten out of eleven cases were resistant to ampicillin. Furthermore, 8/11 cases were resistant to cefazolin, levofloxacin, ciprofloxacin, and cotrimoxazole and 1/11 were resistant to cefoxitin, cefaclor, furantoin, amikacin, and minocycline, and 0/11 were resistant to imipenem, ticarcillin/stick acid, aminotrans. ESBLs positive strains were resistant to 78.6% of the tested drugs (cefaclor, cefazolin, ceftazidime, furantoin, norfloxacin, levofloxacin, ciprofloxacin, cefoxitin, amoxicillin/rod acid, ticarcillin/rod acid, ampicillin, ceftriaxone, cefotaxime, cefuroxime, cefepime, gentamicin, cotrimoxazole, tobramycin, amikacin, tetracycline, chloramphenicol, and minocycline) at a lower rate of resistance than ESBLs positive strains. Of the eight positive cases of E. coli, seven were ESBLs positive, 7/7 were resistant to ampicillin, cefazolin, cefotaxime, cefuroxime, and cefepime, 1/7 were resistant to cefoxitin and minocycline, and 0/7 were resistant to imipenem, furantoin, or amikacin. One case was ESBLs negative and was resistant to all antimicrobial drugs except for ampicillin. Stone recurrence rates at 3, 6, and 12 months after discharge were 9.1%(4/44) and 31.4%(11/35), 13.6%(6/44), respectively, in the high compliance group, and 60.0%(21/35), 36.4%(16/44), and 71.4% (25/35), respectively, in the low compliance group. All differences were statistically significant.Conclusion:The most common pathogenic bacteria isolated from urine bacterial cultures of patients with infectious stones were A. chimaera, E. coli, and K. pneumoniae. The resistance rate of ESBLs-positive strains to antimicrobial drugs was significantly higher than that of ESBL-negative strains, and the resistance rate of antimicrobial drugs such as β-lactamase inhibitors, cefoxitin, amikacin, and imipenem was low. Combination therapy with standardized sensitive antimicrobial drugs and urease inhibitors significantly reduced the recurrence rate of stones among patients.

Vagus nerve reflex is a rare complication of percutaneous renal decompression. It is often induced by excessively rapid decompression of severe hydronephrosis and traction of the main nerves innervating the kidney. The clinical manifestations are irritability, sweating, clammy skin, hiccups, slow heart rate. It is easy to misdiagnose. In this study, 4 patients with vagus nerve excitement after percutaneous renal decompression were treated. After monitoring the patient’s vital signs and giving treatment such as expanding blood volume and raising blood pressure, the symptoms gradually disappeared.