In this comprehensive review, we delve into the evolution of drug delivery systems in reproductive medicine with a focus on the emerging role of exosomes, a class of extracellular vesicles. Exosomes offer unique advantages in overcoming these challenges due to their inherent biocompatibility, stability, and ability to facilitate targeted delivery. This review provides a detailed examination of exosome biogenesis and their function in cellular communication, setting the stage for understanding their potential as drug delivery vehicles. We explore the mechanisms through which exosomes can be loaded with small molecule drugs and the benefits they offer over synthetic nanoparticles. The review highlights groundbreaking case studies that illustrate the successful application of exosome-mediated drug delivery in reproductive health, including enhancing fertility treatments, supporting gamete and embryo development, and facilitating maternal-fetal communication. This study aims to provide a precise understanding of how exosomal drug delivery can revolutionize treatments for reproductive health disorders, paving the way for future therapeutic applications. Lastly, we touch upon the promising therapeutic implications of exosomal delivery for proteins and genes, offering a window into future treatments for reproductive health disorders.

In 2022, American Urological Association updated the guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS). A significant change has been made in treatment recommendations. The updated guideline no longer divided treatments into first-line through sixth-line tiers. Instead, treatment is categorized into behavioral/non-pharmacologic, oral medicines, bladder instillations, procedures, and major surgery. This change emphasizes the heterogeneity of IC/BPS patients and the importance of individualized treatment, overturns traditional unreasonable ideas about hierarchical and progressive treatment, and encourages patients and physicians to make treatment decisions together. At the same time, the panel emphasized the importance of early implementation of cystoscopy in patients suspected of Hunner lesions and warned against the possibility of pentosan polysulfate causing a unique retinal pigmentary maculopathy. Urinary reconstruction surgery was considered to only be used as a last resort for the treatment of IC/BPS, and there is uncertainty about the overall balance between benefits and risks/burdens. The updated guideline provides a new understanding and decision-making basis for the diagnosis and treatment of IC/BPS. However, it should be noted that the clinical characteristics of Chinese patients should be considered in practice and the application of the guideline should be localized.

In 2022, American Urological Association updated the guideline for the diagnosis and treatment of interstitial cystitis/bladder pain syndrome (IC/BPS). A significant change has been made in treatment recommendations. The updated guideline no longer divided treatments into first-line through sixth-line tiers. Instead, treatment is categorized into behavioral/non-pharmacologic, oral medicines, bladder instillations, procedures, and major surgery. This change emphasizes the heterogeneity of IC/BPS patients and the importance of individualized treatment, overturns traditional unreasonable ideas about hierarchical and progressive treatment, and encourages patients and physicians to make treatment decisions together. At the same time, the panel emphasized the importance of early implementation of cystoscopy in patients suspected of Hunner lesions and warned against the possibility of pentosan polysulfate causing a unique retinal pigmentary maculopathy. Urinary reconstruction surgery was considered to only be used as a last resort for the treatment of IC/BPS, and there is uncertainty about the overall balance between benefits and risks/burdens. The updated guideline provides a new understanding and decision-making basis for the diagnosis and treatment of IC/BPS. However, it should be noted that the clinical characteristics of Chinese patients should be considered in practice and the application of the guideline should be localized.

Objective:To compare the efficacy of flexible ureteroscopic lithotripsy (FURL) and NTrap ureteroscopic lithotripsy (NTrapURL) in the treatment of upper ureteral calculi.Methods:A retrospective analysis of the case data of 243 patients undergoing unilateral upper ureteral calculi lithotripsy admitted to the First Hospital of China Medical University from January 2012 to March 2018 were divided into two groups according to different treatment methods: FURL group ( n=74) and NTrapURL group ( n=169). Patients in the FURL group were treated with FURL, and patients in the NTrapURL group were treated with NTrapURL. Operation time, intraoperative stone moving up, postoperative meaningless residual stone, postoperative hospitalstay, stone-free rate, short-term complications (including pain, hematuria, fever) and long-term complications (including ureteral stenosis) were recorded, two surgical methods were analyzed. The measurement data conforming to the normal distribution were expressed as mean±standard deviation ( Mean± SD), and the independent sample t-test was used for comparison between groups; the measurement data of non-normal distribution were expressed as the median (interquartile range) [ M( P25, P75)] means that the non-parametric rank sum test of independent samples was used for comparison between groups; the Chi-square test or Fisher exact probability method was used for the comparison of count data between groups, and the nonparametric rank sum test of ordinal variables was used for grade data. Results:There was not statistically significant difference between the operation time of patients in the FURL group and the NTrapURL group [(31.08±13.29) min vs (33.49±12.10) min]( P=0.582). There was no difference in short-term complications (pain: 43.24% vs 50.30%, fever: 1.35% vs 3.55%, hematuria: 31.08% vs 23.67%) and long-term complications (0 vs 3.55%) in the FURL group and NTrapURL group, there was not statistically significant difference ( P>0.05); the postoperative hospital stay of patients in the FURL group and NTrapURL group [(2.34±0.96) d vs (2.21±0.88) d], the difference was not statistically significant ( P>0.05); The intraoperative stone movement rate of FURL group was significantly higher than that of the NTrapURL group (87.84% vs 18.93%), and the difference was statistically significant ( P<0.001); the first stone clearance rate of the FURL group was higher than that of the NTrapURL group (94.59% vs 81.07%), the difference was statistically significant ( P=0.006); the postoperative insignificant residual stone rate in the FURL group was significantly higher than that in the NTrapURL group (31.08% vs 18.34%), and the difference was statistically significant ( P=0.043). Conclusion:FURL and NTrapURL are safe and effective in the treatment of upper ureteral calculi, but FURL has a higher stone-free in the treatment of upper ureteral calculi.

Objective To compare the different pathological type of renal tumor,clinical epidemiology,imaging and pathological features,summarize its value in the diagnosis of renal tumor.Methods The clinical data of 2198 patients who underwent surgical treatment in our hospital due to renal tumors from January 2010 to January 2019 were retrospectively analyzed.There were 1 404 males and 794 females with an average age of (56.5 ± 11.7) years old.The clinical epidemiology,image features and pathological features were compared.Results Among them,the pathological results concluded 1 891 cases of renal clear cell carcinoma (86.0％),112 cases of papillary renal cell carcinoma (5.1％),76 cases of chromophobe cell carcinoma (3.5％),23 cases of multilocular cystic renal tumors with low malignant potential (1.0％),13 cases of Xp11.2 translocation carcinoma (0.6％),4 cases of collecting duct carcinoma (0.2％),58 cases of anadipotic angiomyolipoma (2.6％),18 cases of acidophiloma (0.8％),and 3 cases of metanephric adenoma (0.1％).The overall differences in age and gender among patients with renal tumors of different pathological types were statistically significant (F =13.8,P ＜ 0.05;x2 =20.5,P ＜ 0.05),Xpl 1.2-translocated carcinoma had the lowest mean age of onset,which was (44.9 ± 17.1 years old).The percentage of women with anadipotic angiomyolipoma was higher (41,70.7％),and the percentage of men with clear cell carcinoma and papillary renal cell carcinoma was higher (1 253,66.3％) and(77,68.8％).There was no statistically significant difference in side sex and clinical manifestations among patients with different pathological types of renal tumors (x2 =16.27,P ＞ 0.05).No significant difference in the distribution of left and right side,the clinical manifestations were mainly sporadic (x2 =19.63,P ＞ 0.05).The results of renal tumors ultrasound ith different pathological types showed statistically significant difference (x2 =67.l,P ＜ 0.05).Hyperechoic (20,34.5％) and mixed echogenicity (16,27.6％) were the main manifestations of lipoma.Multilocular cystic renal tumors with low malignant potential were mostly cystic and solid mixed echogenicity (14,60.9％).CT values of renal tumors of different pathological types at all stages showed statistically significant differences (P ＜ 0.05).The CT values of clear cell carcinoma at the arterial phase of CT enhanced scan were significantly higher than those of other types of tumors (F =11.6,P ＜ 0.05),but decreased significantly in the parenchymal phase,showing the enhancement characteristics of "fast in and fast out".The CT values of papillary cell carcinoma in the third phase of enhanced scan were all lower than those of clear cell carcinoma and chromophobe cell carcinoma (P ＜ 0.05),showing a "progressive enhancement".The enhancement effect of chromophobe cell carcinoma is somewhere in between.The CT value on plain scan of anadipotic angiomyolipoma was higher than that of clear cell carcinoma,and the enhancement was followed by continuous enhancement,showing the characteristics of "fast in and slow out".The majority of clear cell carcinoma and papillary cell carcinoma were tan section (1 235,72.55％;51,52.13％).The grey-white section was the most common type of adipogenic angiomyolipoma (21,40.4％).Conclusions The epidemiological characteristics,imaging and pathological features of renal tumors of different pathological types have certain characteristics,especially the enhanced CT features of renal clear cell carcinoma,papillary renal cell carcinoma,chromophobe cell carcinoma and anadipotic angiomyolipoma,which are of certain value for the differential diagnosis of renal tumors of different pathological types.

Objective To investigate the risk factors of death in patients with syncope. Methods Clinical data of 516 patients experienced syncope admitted from June 2010 to June 2016 were analyzed retrospectively. Factors including gender, age, history of hypertension, diabetes mellitus, hyperlipidemia, smoking history, drinking history, and etiology of syncope (cardiogenic syncope, neuroreflex syncope, orthostatic hypotension, orthostatic syncope, unexplained syncope, and syncope caused by other special diseases) were analyzed as likely risk factors of death within 30 days after syncope happened. After adding the derived variables (over 22 new factors), analyses were done to investigate independent risk factors of death for patients with syncope. Results This study included 321 male (62.2％) and 195 females (37.8％), with mean age of (62.23±19.69) years. Logistic regression analyses showed that age (OR=1.033, 95％ confidence interval (95％CI):1.008-1.058, P =0.008 8),cardiac syncope (OR=19.704,95％CI:5.894-5.875,P＜0.01) were independent risk factors of death within 30 days after syncope occurred. Multiple-variate analysis with derived variables showed that cardiac syncope (OR=11.487, 95％CI:4.938-26.721,P＜0.01),age and age derived variables (OR=1.000, 95％CI:1.000-1.000,P=0.000 8),age and cardiogenic syncope derivative variables (OR=1.033, 95％CI:1.022-1.044, P＜0.01) were independent risk factors for death within 30 days after syncope. Conclusion Age and cardiogenic syncope were independent risk factors for death within 30 days after syncope occurred. And a derivative factor of age, and interactivity between age and cardiac syncope were independent risk factors of death in patients with syncope.

Objective To explore the correlative factors of sudden death in patients suspected with pulmonary thromboembolism (PTE) in emergency room (ER).Methods A retrospective analysis was conducted.The clinical data of 12 patients with sudden death suspected with PTE (sudden death group) in ER of the Air Force General Hospital from January 2011 to June 2014 were analyzed.The non-sudden death group included 35 patients during the same time period who were diagnosed with PTE based on findings of CT pulmonary arteriography (CTPA) and showed no sudden death in ER.Factors,including sex,age,previous operation,tumor,syncope,dyspnea,bilateral or unilateral edema of lower extremity,heart rate (HR),white blood cell count (WBC),D-dimer,arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide (PaCO2) and typical clinical manifestation of electrocardiogram (SⅠTⅢQⅢ),were compared between the two groups.The potential predictors of sudden death of PTE were analyzed by logistic regression analysis.Results Young age (years old:51.3±15.5 vs.62.3±14.4),lower PaO2 [mmHg (1 mmHg =0.133 kPa):49.9± 12.3 vs.62.7± 10.2],higher HR (bpm:122.0± 19.5 vs.89.1 ± 18.5) and higher WBC (× 109/L:13.8 ± 6.9 vs.7.2 ± 2.5) were found in sudden death group as compared with those in non-sudden death group (P ＜ 0.05 or P ＜ 0.01).There was no significant differences in D-dimer level and PaCO2 between sudden death group and non-sudden death group [D-dimer (pg/L):986 (891,3 230) vs.2089 (598,3 397),PaCO2 (mmHg):33.0 (28.6,43.4)vs.36.5 (32.9,41.0),both P ＞ 0.05].The syncope,antineoplaston treatment or tumor metastasis within 6 months,operation in previous 4 months,bilateral asymmetrical edema in sudden death group were more than those of the non-sudden death group,and chest pain was less (P ＜ 0.05 or P ＜ 0.01).Difference in gender,dyspnea and typical SⅠTⅢQⅢ in electrocardiogram were not significant between the two groups (all P ＞ 0.05).It was shown by multiple logistic regression analysis that higher HR [odds ratio (OR) =1.124,95％ confidence interval (95％CI) =1.024-1.235,P =0.014] and higher WBC (OR =1.347,95％CI =1.043-1.738,P =0.022) were identified as independent risk factors of sudden death for PTE.Conclusions Gender,dyspnea,typical S Ⅰ TⅢQⅢ in electrocardiogram,PaCO2 and D-dimer seem unrelated to sudden death of patients with PTE.Young age,chest pain,syncope,bilateral asymmetrical edema,antineoplaston treatment or tumor metastasis within 6 months,operation in previous 4 months and low PaO2 were potential predictors of sudden death according to the univariate analysis.Higher WBC and higher HR are independent risk factors of sudden death for PTE patients.

Objective The aim of this study was to investigate the understanding and application of the Chinese Urological Association (CUA) guidelines of Benign Prostatic Hyperplasia (BPH) (2011 edition) in Chinese urologists.Methods The survey was conducted between September,2012 and November,2012.Questionnaires designed by the CUA were used to investigate the understanding and management of BPH in CUA-registered urologists,who work in clinic for at least 20 hours per week.Data,including general characteristics of the urologists,understanding of BPH,BPH diagnosing in suspected patients,BPH treatment,and follow up,were collected.7500 questionnaires were distributed.A total of 4 897 participants responded (response rate 70.0％).86 questionnaires with incomplete information and 37 duplicate questionnaires were excluded.And 4 774 validate questionnaires were included for the analysis,finally.The mean age of those investigated urologists was (39.9±9.2) years old.Among them,3 802 (81.0％) urologists work in the tertiary hospital,878 (18.7％) urologists work in the secondary hospital and 12 (0.3％) urologists work in the other hospital.The district distribution in those urologists included 455 (9.6％) in northeast china,812 (17.1％) in north china,1 696 (35.6％) in east china,869 (18.2％) in south china,634 (13.3％) in southwest china,295 (6.2％) in northwest china.1 835 (43.8％) urologists have less than ten years working experience.1 505 (35.9％) urologists have 11 to 20 years working experience.The 21 to 20 years working experience was reported in 705 (16.8％) urologist.And the other 149 (3.5％) urologists have working experience more than 31 years.The educational background in this study included doctor degree in 732 (15.8％) urologists,master degree in 1 729 (37.4％) urologists,bachelor degree in 2 067 (44.7％)urologists and college degree in 101 (2.1％) urologists.The position composition included 834 (18.2) directors,1 371 (30.0％) deputy directors,1 605 (35.1％) attendings and 765 (16.7％) residents.The data were analyzed using rank-sum test,2 test,or Fisher's exact test.Results The understanding of BPH clinical progression and progression-associated risk factors in Chinese urologists was poor.Compared to the guidelines,the rate of consistent were only 43.4％ (2 023/4 665) and 10.2％ (477/4 660),respectively.The initial evaluation methods for suspected BPH patients were in low consistency with the guidelines (20.2％,845/4 181) and were inconsistent among different areas [66.5％ (290/436) in northeast china,64.7％ (556/859) in south china,55.6％ (158/284) in northwest china,55.1％ (922/1 672) in east china,54.7％ (435/795) in north china,48.0％ (296/617) in southwest china].The participants showed poor understanding of the primary goal of treatment for BPH (4.9％ consistent,229/4 666) and the criteria about watchful waiting (22.5％ consistent,1 051/4 674).However,the understanding of surgical indications for BPH was good (94.6％ consistent,4 410/4 663).The therapeutic effects of 5α-reductase inhibitor for BPH were acknowledged by 93.4％ (4 388/4 699) participants.The consistent rate with the guidelines of follow-up examinations was low for patients with watchful waiting (7.8％,355/4 531),medication treatment (8.4％,373/4432),and surgery (44.8％,2 105/4 702).Conclusions The understanding of the CUA BPH guidelines is poor in Chinese urologists.Target training in the specific urologists with tailored contents is necessary.

Objective To evaluate the safety,efficacy,experience and techniques of percutaneous nephrostolithotomy (PCNL) in treating renal staghorn calculi.Methods The clinical data of 60 patients with staghorn renal stone who underwent PCNL were analyzed retrospectively.Results The stone free rate was 68.3％(41/60) in the first procedure.Three patients were performed a secondary procedure.The stone free rate was 73.3％ (44/60) in the second procedure.The total stone free rate was 93.3％(56/60) after the procedure of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic lithotripsy (URL).Conclusions PCNL is a safe and effective method for the staghorn renal calculi.The stone free rate may be improved with skilled operation experience and combination with ESWL and/or URL.