Objective:To investigate the efficacy of rigid ureteroscopic laser lithotripsy combined with N-trap(RULL+N-trap),which is scoop-shaped,in the treatment of ureteral stones with a maximum diameter ≥1.5 cm.Methods:This retrospective cohort study included patients diagnosed with ureteral calculi who underwent rigid ureteroscopic lithotripsy(RULL)combined with N-Trap stone entrapment system at the Department of Urology,Peking University Third Hospital,by the same surgical team between June 2021 and September 2024.A total of 364 patients were initially enrolled.After excluding 21 patients due to missing critical outcome variables,two distinct cohorts were established:38 patients with ureteral stones measuring ≥1.5 cm in maximum diameter,and 305 patients with stones＜1.5 cm in maximum diameter.To minimize selection bias and control for confounding variables,propensity score matching(PSM)was employed.This resulted in two well-balanced groups:31 patients with stones 1.5 cm in maximum diameter and 31 patients with stones＜1.5 cm in maximum diameter,matched on baseline demographic and clinical characteristics.The primary outcomes assessed between the two groups included stone clearance.Secondary outcomes included changes in renal function indicators,specifically serum creatinine(SCr)and estimated glomerular filtration rate(GFR),and other factors like postopera-tive hospital stay and operative time.Results:In the matched cohort,the patients with stones ≥1.5 cm in maximum diameter had significantly longer operative time compared with those with smaller stones:(85.8±28.8)min vs.(62.4±24.6)min(P＜0.05).Postoperative length of hospital stay showed no significant difference:(2.26±1.79)d vs.(2.03±0.80)d(P＞0.05).The stone clearance on postoperative day one was 90.3％in the study group vs.100.0％in the control group(P＞0.05).One month postoperatively,the stone clearance was 93.5％vs.100.0％,respectively(P＞0.05).Changes in SCr were(-6.58±16.10)μmol/L vs.(-13.70±12.50)μmol/L,and changes in GFR were(5.92±14.90)mL/(min·1.73 m2)vs.(7.47±11.20)m L/(min·1.73 m2),with no statistically significant differences observed between the two groups for either renal function marker(P＞0.05).Conclusion:Ureteroscopic lithotripsy combined with N-trap is an optional method for treating ureteral stones with a maximum diameter ≥1.5 cm.The overall therapeutic efficacy is comparable,with the added benefit of significantly reducing the economic burden on patients.

Objective:To investigate the efficacy of rigid ureteroscopic laser lithotripsy combined with N-trap(RULL+N-trap),which is scoop-shaped,in the treatment of ureteral stones with a maximum diameter ≥1.5 cm.Methods:This retrospective cohort study included patients diagnosed with ureteral calculi who underwent rigid ureteroscopic lithotripsy(RULL)combined with N-Trap stone entrapment system at the Department of Urology,Peking University Third Hospital,by the same surgical team between June 2021 and September 2024.A total of 364 patients were initially enrolled.After excluding 21 patients due to missing critical outcome variables,two distinct cohorts were established:38 patients with ureteral stones measuring ≥1.5 cm in maximum diameter,and 305 patients with stones＜1.5 cm in maximum diameter.To minimize selection bias and control for confounding variables,propensity score matching(PSM)was employed.This resulted in two well-balanced groups:31 patients with stones 1.5 cm in maximum diameter and 31 patients with stones＜1.5 cm in maximum diameter,matched on baseline demographic and clinical characteristics.The primary outcomes assessed between the two groups included stone clearance.Secondary outcomes included changes in renal function indicators,specifically serum creatinine(SCr)and estimated glomerular filtration rate(GFR),and other factors like postopera-tive hospital stay and operative time.Results:In the matched cohort,the patients with stones ≥1.5 cm in maximum diameter had significantly longer operative time compared with those with smaller stones:(85.8±28.8)min vs.(62.4±24.6)min(P＜0.05).Postoperative length of hospital stay showed no significant difference:(2.26±1.79)d vs.(2.03±0.80)d(P＞0.05).The stone clearance on postoperative day one was 90.3％in the study group vs.100.0％in the control group(P＞0.05).One month postoperatively,the stone clearance was 93.5％vs.100.0％,respectively(P＞0.05).Changes in SCr were(-6.58±16.10)μmol/L vs.(-13.70±12.50)μmol/L,and changes in GFR were(5.92±14.90)mL/(min·1.73 m2)vs.(7.47±11.20)m L/(min·1.73 m2),with no statistically significant differences observed between the two groups for either renal function marker(P＞0.05).Conclusion:Ureteroscopic lithotripsy combined with N-trap is an optional method for treating ureteral stones with a maximum diameter ≥1.5 cm.The overall therapeutic efficacy is comparable,with the added benefit of significantly reducing the economic burden on patients.

Objective:To review and analyze the clinical diagnosis and treatment of renal Ewing's sar-coma with venous tumor embolus,to follow up the survival and prognosis of the patients,and to provide help for the diagnosis and treatment of the disease.Methods:Clinical data(including general data,sur-gical data and postoperative pathological data)of patients diagnosed with renal Ewing's sarcoma with ve-nous tumor embolus in Peking University Third Hospital from June 2016 to June 2022 were collected,and the prognosis of the patients was followed up to analyze the influence of diagnosis and treatment process on the prognosis of the disease.Results:There were 6 patients,including 1 male and 5 females.There were 4 cases of left renal tumor and 2 cases of right renal tumor.The median age at diagnosis was 28 years(16-52 years).The imaging findings were all exogenous tumors with internal necrotic tissue and hemorrhage.The mean maximum tumor diameter was 12.6 cm,and the mean tumor thrombus length was 7.8 cm.Four patients underwent open surgery and 2 patients underwent laparoscopic surgery.The post-operative pathological results were renal Ewing sarcoma.Immunohistochemical results showed 3 cases of CD99(+),2 cases of FLI-1(+),and 1 case of CD99,FLI-1(-).3 patients received chemothera-py(cyclophosphamide,doxorubicin,vincristine/ifosfamide,etoposide),1 case received chemotherapy combined with radiotherapy,and 2 cases received no adjuvant therapy.The mean overall survival(OS)of the 6 patients was 37 months,and the mean OS of the 4 patients(47 months)who received chemo-therapy was significantly higher than that of the 2 patients(16 months)who did not receive chemotherapy(P=0.031).Conclusion:Renal Ewing's sarcoma with venous tumor embolus is rare in clinic,and it is common in young female patients.The operation is difficult and the prognosis is poor.Surgical resection,adjuvant radiotherapy and chemotherapy can improve the overall survival rate of the patients.

Objective:To Explore the diagnosis, treatment and prognosis of FH-deficient renal cell carcinoma (FH-deficient RCC) with tumor thrombus, and share surgical experience.Methods:From August 2019 to October 2022, 6 cases of FH-deficient RCC with tumor thrombus were diagnosed and treated in our center, including 4 males and 2 females. The patients were aged 22 to 57 years, with 2 cases younger than 40 years, icluding 5 cases on the left and 1 case on the right. The median maximum diameter of the tumor is 8 (4.8, 14.0) cm. Operations were performed after complete examination (enhanced CT and other related examinations). One case underwent open surgery and palliative resection of the left kidney was performed because of severe adhesion of the inferior vena cava. Among the remaining 5 cases, 1 case underwent retroperitoneal laparoscopic right radical nephrectomy with inferior vena cava thrombectomy, 1 case underwent transabdominal laparoscopic left radical nephrectomy with inferior vena cava thrombectomy, and 3 cases underwent robot assisted laparoscopic left radical nephrectomy with inferior vena cava thrombectomy.Results:The median surgical time was 293 (185, 366) min, with blockage of the vena cava for 13 min and 28 min in 2 of 6 cases, respectively. The pathological report of renal tumor and tumor thrombus was FH-deficient renal carcinoma. The pathological features were as follows: the gross section of the specimen was gray yellow solid, often accompanied by necrosis, and the cystic cavity could be seen locally. Microscopically, the tumor extensively involved the renal parenchyma, with papillary, cribriform and tubular cystic structures. Immunohistochemistry showed FH (-), 2SC (+ ). The median postoperative hospital stay was 8 (4, 15) days. The median follow-up time was 13 (4, 27) months. One patient undergoing palliative resection of the left kidney underwent targeted therapy and radiotherapy after surgery (died 15 months after surgery due to gastrointestinal perforation). During the follow-up process, 4 cases experienced metastasis and received systematic treatment, with 1 death 27 months after surgery. Uterine leiomyomas were found in the remaining 1 case during follow-up.Conclusions:FH-deficient RCC with tumor thrombus is very rare. This disease is highly invasive, difficult to be diagnosed preoperatively and poor clinically prognostic. Operation combined with systemic therapy is an effective way to treat FH-deficient RCC with tumor thrombus.

Objective:To investigate the efficacy and safety of laparoscopic partial nephrectomy in the treatment of renal tumors with renal score of 10.Methods:From February 2016 to March 2021, 23 patients who underwent laparoscopic partial nephrectomy in Peking University Third Hospital with renal tumors of R. E.N.A.L. score of 10 was studied retrospectively, including 16 cases of male and 7 cases of female, with 11 cases on the right side and 12 cases on the left side. The patients’ age was (55.0±16.4) years, and BMI was (25.4±3.6) kg/m 2. The maximum diameter of the tumor was (3.5±1.4)cm. Laparoscopic partial nephrectomy was performed after complete examination. The observation indexes included operation time, blocking time, complications, postoperative hospital stay and the trifecta (negative surgical margin, blocking time ≤25 minutes, and no perioperative complications). Results:All operations were successfully completed, only 4 cases were converted to open surgery. The median operation time was 153 min(99-346 min). The median blocking time was 27 min(14-60min). The median postoperative hospital stay was 6 d(4-11 d). Postoperative complications occurred in 7 cases(fever in 5 cases, intestinal obstruction in 1 case, postoperative blood transfusion and leg intermuscular venous thrombosis in 1 case). 9 cases (39.1%) achieved the trifecta. 19 cases who completed by laparoscopy, their operation time was 151 min(99-303 min), blocking time was 28 min(18-60 min), postoperative hospital stay was 6 d(4-11 d), fever occurred in 4 cases, and 6 cases achieved the trifecta (31.6%). The follow-up time was 3-62 months, with a median of 32 months, and there was no recurrence or metastasis.Conclusions:Laparoscopic partial nephrectomy is safe and effective in the treatment of renal tumors with renal score of 10.Although the tumor is highly complex, it also achieves the purpose of preserving nephron to the greatest extent. If technical conditions permit, laparoscopic partial nephrectomy could be considered for the treatment of highly complex renal tumors.

Objective:To analyze the prognostic factors of primary and metastatic tumor resection for metastatic renal carcinoma.Methods:Clinical data of 12 cases of renal carcinoma with distant metastasis admitted to the Peking University Third Hospital from June 2011 to December 2019 were analyzed retrospectively, including 10 males and 2 females. Age was from 36 to 67 years old, with average of 53.7 years old. BMI was 20.9-30.8 kg/m 2, with average of 25.8 kg/m 2.There were 6 cases of right kidney tumor and 6 cases of left kidney tumor. The diameter of the primary tumor was 2.7-16.0 cm, with an average of 7.1 cm. There were 2 cases of lung metastasis, 1 case of liver metastasis and 9 cases of bone metastasis. All the 12 patients underwent primary and metastatic tumorectomy. Postoperative pathological results showed 10 cases of clear cell carcinoma, 1 case of papillary type 2 tumor and 1 case of collecting duct carcinoma. The pathological results of the metastases were the same as those of the original lesions. Results:All the 12 patients underwent primary and metastatic renal carcinoma resection, among which 3 received postoperative chemotherapy and 6 received radiotherapy .Two patients were treated with targeted drugs. The interval between primary resection and metastatic resection was 1-84 months, and the median time was 2.5 months. In this study, 12 patients were followed up for 2-96 months, with the median survival time of 34 months, and mortality rate of 25%.There was no significant correlation between age( P=0.265), gender( P=0.183), BMI( P=0.152), primary tumor size ( P=0.082), radiotherapy, chemotherapy or targeted therapy ( P=0.915) and overall survival, and the interval between primary resection and metastatic resection ( P=0.046) was significantly correlated with overall survival. Conclusion:The interval between primary and metastatic tumor resection was a risk factor for the prognosis of patients.

Objective:To explore the value of preoperative aspartate transaminase(AST) and aspartate transaminase/alanine transaminase ratio(AST/ALT)for predicting the prognosis in patients with non-metastatic renal cell carcinoma with tumor thrombus.Methods:A retrospective analysis was made of the patients with renal cell carcinoma with tumor thrombus in our institution from February 2015 to December 2018. This study included 80 patients, 56 males and 24 females with mean age of 58 years (range 15-83 years). There were 17 in Mayo level 0, 24 Mayo level I, 22 in Mayo level II, 12 in Mayo level III and 5 in Mayo level IV. All the patients received radical nephrectomy or palliative nephrectomy with tumor thrombectomy. The continuous variable of AST/ALT was collected by ROC curve. The maximum value of Youden index was taken as the critical value, and the continuous variables were adjusted to binary variables. Cancer-specific survival (CSS) was calculated according to the Kaplan-Meier analysis and compared by the log-rank test. Cox multivariate regression analysis was used to analyze the independent factors of the prognosis of patients with non-metastatic renal cancer and tumor thrombus.Results:There were 70 cases of clear cell carcinoma, 10 cases of non-clear cell carcinoma, 30 cases of low Fuhrman grade (grade 1&2), and 50 cases of high Fuhrman grade (grade 3&4). AST was 19U/L (8-226 U/L) and AST/ALT was 1.3(0.4-3.3). There was a significant difference in AST between different lymphovascular invasion groups ( P=0.04), but there was no significant difference in sex, age, Mayo classification, pathological type, Fuhrman grade and lymph node metastasis. The difference of AST / ALT between age groups was significant ( P=0.025). The average follow-up time was 14.7 months (0-44 months). During the follow-up, 11 (13.8%) patients died of tumor. Univariate analysis showed that Fuhrman grade ( P=0.007), lymph node metastasis ( P=0.019), hemoglobin ( P=0.001), alkaline phosphatase (ALP, P=0.001), AST ( P=0.004) and AST / ALT ( P=0.038) were risk factors for CSS. In terms of prognosis, considering the potential correlation between AST level and AST/ALT ratio, after excluding AST, multivariate Cox regression analysis showed that high nuclear grade ( HR=3.049, 95% CI 1.292-7.196, P=0.011), high ALP ( HR=1.018, 95% CI 1.007-1.029, P=0.001) and high AST/ALT ratio ( HR=4.094, 95% CI 1.064-15.759, P=0.04) were associated with poor CSS. After excluding AST/ALT ratio, multivariate Cox regression analysis showed that high nuclear grade ( HR=5.836, 95% CI 1.867-18.240, P=0.002) and high AST ( HR=1.040, 95% CI 1.017-1.062, P<0.001) were associated with poor CSS. Conclusions:In patients with non-metastatic renal cell carcinoma with tumor thrombus, high AST/ALT ratio and AST levels indicate poor pathological types and poor prognosis.

Objective To investigate the pathological features and prognostic value of rend tumor venous thrombus.Methods The clinical data of 55 cases of renal cell carcinoma with inferior vena cava tumor thrombus treated from January 2015 to January 2017 were collected and analyzed retrospectively,including 46 males and 9 females,with the mean age of 60 years (29-82 years),and the body mass index of 16.4-33.0 kg/m2 (mean 24.2 kg/m2).Renal tumors are located on the right side of 37 cases and on the left side of 18 cases.The diameter of the tumor was 2.0-21.1 cm (mean 8.0 cm).Mayo classification were 13 cases of grade 0,11 cases of grade Ⅰ,19 cases of grade Ⅱ,7 cases of grade Ⅲ,and 5 cases of grade Ⅳ.The patients' paraffin pathology was reviewed and the classification,grade,nuclear grade,tumor composition,and vascular wall adhesion were recorded.All patients were followed up after surgery and the relationship between the characteristics and the prognosis was analyzed.Results There were 47 cases of renal clear cell carcinoma and 8 cases of papillary renal cell carcinoma type 2.Nuclear grade was 4 cases of grade 1,20 cases of grade 2,25 cases of grade 3,and 6 cases of grade 4.There were 11 cases of large tumor necrosis,6 cases of sarcoma,and 38 cases of focal or no necrosis.There were 20 cases of extensive blood vessels adhesion of cancer thrombus,and 35 cases of focal or no adhesion.Vascular adhesion was associated with pathological types and tumor types (P =0.021,P =0.036).The median follow-up duration was 17 months.The postoperative one-year survival rate was 87.3％.Overall survival was different in patients with different tumor types,vascular adhesion and nuclear grade,among which the overall survival rate (33.3％) of the sarcoma group was significantly lower than that of the non-necrotic group (84.8％,P=0.003) and large necrotic group (100.0％,P =0.002).Overall survival rate (65.0％) was significantly lower in the vascular extensive adhesion group than in the focal or non-adhesion group (94.3％,P =0.005).The survival rate decreased as nuclear grade increased,among which the overall survival rate of patients at level 1,2,3 and 4 were 100％,95％,80％ and 50％ respectively (P =0.045).There was no difference in survival among patients with different Mayo grading and pathological classification (P =0.426,P =0.604).Conclusions The pathology of tumor thrombus in renal cancer helps to predict prognosis.There is no significant difference in survival among patients with different pathological types and Mayo grades.Sarcoma,advanced tumor nuclear grade and vascular adhesion of tumor thrombus are adverse prognostic factors.

Objective To investigate the adverse risk factors of urinary function recovery after radical prostatectomy.Methods The clinical data of 126 patients treated with laparoscopic radical prostatectomy from October 2015 to October 2016 were collected and analyzed retrospectively.The mean age was 70 years (48-85 years).The BMI was 16.8-24.7 kg/m2(mean 24.6 kg/m2).The PSA was 1.73-274.5 ng/ml (median 12.06 ng/ml).26 cases had positive surgical margins.There were 62 cases in lower age group (＜70 years) and 64 cases in higher age group(≥70 years).The BMI of the lower age group and the higher age group were (25.35-± 3.66) and (24.00 ± 3.11) kg/m2 (P =0.028).The median PSA of the lower age group and the higher age group were 13.41 and 10.26 ng/ml(P =0.304).The PSA ＜ 10、10-20、＞ 20 ng/ml for two groups were 22,17,20 and 29,18,20 (P =0.41).The Gleason ≤ 6,7,≥ 8scores for two groups were 6,18,38 and 7,24,33 (P =0.168).All patients were followed up for 48 weeks,and the risk factors for patients with poor control of uhnary function were analyzed.Results The overall recovery rate of continence 12 weeks after surgery was 46.8％ (59/126),with lower age group 56.5％ (35/62) and higher age group 37.5％ (24/64) (P ＜0.05).The rate of 24 weeks after surgery was 88.1％ (111/126),with lower age group 93.5％ (58/62)and higher age group 82.8％ (53/64)(P ＜0.05).In a univariate logistic regression test,the age (P =0.034),BMI (P =0.044) and nerve sparing (P =0.005) were associated with recovery of urinary continence within 12 weeks after surgery (P ＜ 0.05).In multivariate logistic regression analysis,age (P =0.011),BMI (P =0.022) and nerve reserved (P =0.014) were independent factors that predicted the recovery of continence within 12 weeks after surgery (P ＜ 0.05).Conclusions Younger age,lower BMI and intraoperative nerve preservation independently predicted recovery of continence within 12 weeks.Age is the influencing factor of continence recovery within 24 weeks.

Objective To investigate the clinicopathological features, treatment modalities, and prognostic factors for survival in patients with urinary tract small cell carcinoma (UT-SCC).Methods A total of 25 patients treated from June 2000 to December 2014 were included in the retrospective study.The data included age, gender, primary tumors origins, stage, treatment modalities, progression-free survival (PFS), overall survival (OS), pathology and immunohistochemistry.Of these cases, 22 were male, and the other was female, whose age was 45-79 years (mean age 67).20 cases small cell carcinoma of bladder patients and 2 small cell carcinoma of prostate cancer patients were included.The number of small cell carcinoma in pelvis,ureter and retroperitoneal was 1 respectively.The patients with small cell carcinoma of the urinary tract were classified as disease and extensive disease.17 bladder small cell carcinomas were limited disease and 3 cases were extensive disease;Prostate small cell carcinomas were both extensive disease;The small cell carcinomas in pelvis, ureter were limited disease;The small cell carcinoma in retroperitoneal was extensive disease.10 bladder small cell carcinomas which were limited disease received radical cystectomy.6 of 10 patients received etoposide and cisplatnum (EC).4 of 10 patients received gemcitabine and cisplatnum (GC).7 bladder small cell carcinomas patients who with limited disease refused to receive radical cystectomy in which 2 patients received TURBT and 5 patients received TURBT followed chemotherapy.Both prostate small cell carcinomas received chemoradiotherapy.2 small cell carcinomas in upper urinary tract (pelvis and ureter) received radical nephroureterectomy with bladder cuff resection.The patient of retroperitoneal small cell carcinoma received percutaneous nephrostomy after biopsy.The progression-free survival (PFS) and overall survival (OS) of these patients are analyzed;the influence of TURBT with adjuvant chemotherapy and clinicopathologic characteristics were analyzed in median PFS and OS.PFS and OS were compared between groups as a function of time, using a Kaplan-Meier survival curve analysis and the log-rank significance test.All statistical tests were two-sided, and P values ＜ 0.05 were considered statistically significant.Results 25 patients with a pathologic confirmation of UT-SCC,either by biopsy or surgery,were finally included.These patients were classified as pure UT-SCC (14) and Mixed UT-SCC (11).Mixed UT-SCC was defined as tumors containing both SCC and non-SCC components,regardless of the proportion of the latter.13 cases were strongly positive and 3 cases were weakly positive in neuron specific enolase (NSE) level.8 cases were strongly positive and 2 cases were weakly positive in CgA level.Patients with limited disease experienced a significant longer PFS and OS compared with extensive disease subjects (PFS 13.2 vs.7.8 x2=13.53 P＜0.01;OS27.2 vs.12.7x2=19.88 P＜0.01).Patients with bladder SCC showed a significantly higher median PFS and OS compared with patients with SCC of other parts of urinary tract (PFS 12.8 vs.8.2 x2 =12.00, P =0.001;OS 26.3 vs.13.2 x2 =14.45,P ＜0.01) .The two different chemotherapy regimens (GC and EC) have no influence on survival (PFS: 16.3 vs.12.5,x2 =3.34, P =0.07;OS 29.5 vs.22.8, x2 =1.66, P =0.198).TURBT followed by adjuvant therapy have no influence on survival (PFS 14.5 vs.12.0 t =1.30 P =0.251;OS 24.5 vs.28.4 t =0.50,P =0.636).Conclusions The primary tumors origins and stage may have influence on survival in patients with UT-SCC.Patients with bladder small cell carcinoma and limited disease experienced a longer survival.