Sarcopenia is observed to have age-related loss of skeletal muscle mass, muscle strength and physical performance, which can be an effective prognostic indicator for postoperative complications and poor survival outcomes in tumor patients. Sarcopenia could reflect tumor-host interactions and has the advantages in accuracy and generality compared with traditional predictors. This paper reviews the research progress of sarcopenia in predicting the prognosis of genitourinary tumors.

Objective To evaluate the predictive values of serum neutrophil gelatinase-associated lipocalin (NGAL), urine NGAL, serum cystatin C (Cys-C) and serum creatinine (Scr) for early delayed graft function (DGF) in kidney transplant recipients. Methods Clinical data, blood and urine samples of 159 kidney transplant recipients were collected. All recipients were divided into the DGF group (n=42) and immediate graft function (IGF) group (n=117) according to the incidence of DGF. Clinical data of all recipients were analyzed. The changes of serum NGAL, urine NGAL, Cys-C and Scr levels were statistically compared between two groups. The predictive values of different markers for early DGF were assessed. Results Among 159 kidney transplant recipients, DGF occurred in 42 cases with an incidence rate of 26.4%. There were statistically significant differences in donor age, cold ischemia time of donor kidney and complement-dependent cytoxicity (CDC) between the two groups(all P < 0.05). Within postoperative 2 weeks, the serum NGAL levels in the DGF group were higher than those in the IGF group (all P < 0.05). The Cys-C, Scr and urine NGAL levels in the DGF group were higher compared with those in the IGF group within 3 weeks after kidney transplantation(all P < 0.001). Serum NGAL, urine NGAL, Cys-C and Scr levels had certain predictive values for early DGF in kidney transplant recipients. Cys-C yielded the highest predictive value with a cut-off value of 4.73 mg/L, sensitivity of 0.833, specificity of 0.812 and area under the curve (AUC) of 0.895. Conclusions Cys-C has higher predictive value for early DGF in kidney transplant recipients compared with serum NGAL, urine NGAL and Scr.

Objective:To understand the application effect of traditional position and oblique supine lithotomy in percutaneous nephroscopy combined with ureteroscopy combined with double lithography, and explore the clinical nursing methods of oblique supine lithotomy.Methods:From January 2018 to January 2019 in our hospital, 82 patients with complicated calculi who underwent percutaneous nephroscopy combined with ureteroscopy and double lithoscopy were selected, and were divided into the control group ( n=40) and the observation group according to the random number table ( n=42). The control group took the lithotomy position after anesthesia, placed the ureteral stent tube and changed it to the prone position to complete the operation; the observation group placed the oblique supine lithotomy position to complete the operation after anesthesia, and there was no need to change the position during the operation. The posture time, blood pressure, heart rate, pulse oxygen, blood transfusion, bleeding, postoperative postural comfort and complications of the two groups were compared. Results:When placed in the position and at the end of the operation, the blood pressure of the control group was (109±31), (106±23) mmHg(1 mmHg=0.133 kPa), and the heart rate was (93 ±10), (95±15)times per minute; the blood pressure of the observation group was (130±19), (125±17)mmHg, the heart rate was (86±12), (85±9) times per minute, the difference between the two groups was statistically significant ( t value was 2.86-4.26, P<0.01). The posture time of the observation group was (12.4±3.0) min and the control group was (21.2±6.9) min with statistically significant difference between two groups( t value was 7.550, P<0.01). The number of uncomfortable patients in the observation group after operation was 3 cases and 7 cases occurred in the control group. The difference was statistically significant ( χ2 value was 2.450, P<0.05). Conclusion:It is safe and feasible to use the oblique supine lithotomy position in double -lens combined stone removal, which can reduce the patient's discomfort and complications, and effectively improve the surgical efficiency and quality.

Objective To evaluate the consistency among the results of preoperative midstream urine culture (PMUC), renal pelvis urine culture (RPUC) and renal stone (RSC) culture in patients undergoing percutaneous nephrolithotomy (PNL) and their relationship with postoperative infection. Methods This was a multicenter prospective study. From September 2014 to November 2017, 115 patients undergoing standard channel PNL or microchannel PNL in the First Affiliated Hospital of Soochow University and Yancheng Hospital of Traditional Chinese Medicine were selected. The PMUC, RPUC and RSC were detected. Samples for RPUC and RSC were obtained during PNL. The clinical data, stone configuration, stone burden and results of cultures were recorded. Results In the 115 patients, PMUC positive was in 4 cases (3.5%), RPUC positive was in 17 cases (14.8%), and RSC positive was in 16 cases (13.9% ); both RPUC and RSC positive were in 7 cases (6.1% ), among whom consistent pathogenic bacterium was in 6 cases, and inconsistent pathogenic bacterium was in 1 case; all the 3 cultures were positive in 1 case, but the types of pathogenic bacterium of PMUC were totally different with RPUC and RSC. At least one positive of the 3 cultures was in 29 cases (25.2% ). The types of pathogenic bacterium of PMUC were multidrug susceptible Escherichia coli and Staphylococcus aureus , and the types of pathogenic bacterium of RPUC and RSC were multidrug resistant pathogens and/or fungus. The consistency of pathogenic bacterium between PMUC and RPUC, RSC was very low; while the consistency of pathogenic bacterium between RPUC and RSC was very high (6/7). Postoperative infection occurred in 8 of 115 patients (7.0% , 5 cases of infective fever and 3 cases of urinary sepsis). In the 8 patients, PMUC was negative, PRUC positive in 4 cases, RSC positive in 7 cases, and both PRUC and RSC positive were in 3 cases. Conclusions PMUC can not accurately reflect the true situation of upper urinary tract renal calculi and pyelo-urine pathogenic bacterium. In patients with PNL postoperative infectious complications, the result of PMUC is often negative, but the results of RPUC and RSC are mostly positive. RPUC and RSC are helpful to detecting pathogenic bacterium in time, guiding the application of sensitive antibiotics, preventing and treating PNL postoperative infection.

Objective To investigate the relationship between the interleukin (IL)-35 and the recovery of renal graft function. Methods Clinical data of 45 recipients receiving renal transplantation from donation after cardiac death (DCD) were retrospectively analyzed. According to the presence of delayed graft function (DGF) after renal transplantation, all recipients were divided into the immediate graft function (IGF) group (n=32) and DGF group (n=13). The serum creatinine (Scr) level and estimated glomerular filtration rate (eGFR) in the recipients were statistically compared between two groups at 1, 2, 3, 7, 14, 28 d and 3, 6 and 12 months after renal transplantation. The IL-35 levels in the serum and urine samples of the recipients were statistically compared between two groups at 1, 2, 3, 7, 14, 28 d following renal transplantation. Results In the DGF group, the renal function was restored slowly. Compared with the IGF group, the Scr level was significantly higher, whereas the eGFR was considerably lower in the DGF group at postoperative 7 d (both P<0.05). At 1 year after surgery, there was no significant difference in the Scr level between two groups. Compared with the IGF group, the eGFR in the DGF group was significantly lower at postoperative 1 year (P<0.05). At 1, 2, 3, 7, 14 d after operation, the serum levels of IL-35 in the DGF group were evidently lower than those in the IGF group (all P<0.05). Compared with the IGF group, the serum level of IL-35 in the DGF group was significantly increased at postoperative 28 d (P<0.05). At postoperative 1, 2, 3, 7 d, the IL-35 levels in the urine samples in the DGF group were significantly lower than those in the IGF group (all P<0.05). At postoperative 14 and 28 d, the IL-35 levels in the urine samples did not significantly differ between two groups (both P>0.05). Conclusions The low levels of IL-35 in the serum and urine of recipients after renal transplantation are associated with the incidence of DGF to certain extent, prompting that excessively weak systemic and local anti-inflammatory responses early after renal transplantation and uncontrolled excessive inflammatory response are probably the pivotal causes of DGF.

Objective To study the effect of puncture length per cubic centimeter of prostate biopsy on the detection rate of prostate cancer. Methods The clinical data of 254 prostate cancer patients who had underwent the first prostate biopsy by transrectal ultrasound guidance from September 2013 to November 2017 were retrospectively analyzed. The patients were divided into prostate cancer group and non prostate cancer group according to biopsy pathologic results. The total prostate specific antigen (TPSA), prostate volume, puncture length per needle, puncture length per cubic centimeter of prostate, volume of per needle and percentage of the sampled prostate volume were compared between 2 groups, and the relationship between puncture length per cubic centimeter of prostate and prostate cancer detection rate were analyzed. Results Among the 254 patients, the prostate cancer was in 67 cases (prostate cancer group), and the benign lesion was in 187 cases (non prostate cancer group). The prostate cancer detection rate was 26.4% (67/254). There were no statistical differences in age, puncture length per needle and volume of per needle between 2 groups (P＞0.05). The TPSA, puncture length per cubic centimeter of prostate and percentage of the sampled prostate volume in prostate cancer group were significantly higher than those in non prostate cancer group: (13.8 ± 6.8)×103 ng/L vs. (8.5 ± 3.9)×103 ng/L, (3.42 ± 0.12) mm/cm3 vs. (2.83 ± 0.18) mm/cm3 and (2.75 ± 0.31)% vs. (2.24 ± 0.25)%, the prostate volume was significantly lower than that in non prostate cancer group: (45.8 ± 15.5) cm3vs. (56.3 ± 13.8) cm3, and there were statistical differences (P＜0.05). Receiver operating characteristic curve analysis showed that area under the curve was 0.628, 95% CI 0.561 to 0.695. The cutoff value of puncture length per cubic centimeter of prostate was 3.40 mm/cm3, with the sensitivity of 59.8% and the specificity of 64.8% . Conclusions The puncture length per cubic centimeter of prostate and percentage of the sampled prostate volume are important morphometric parameters in the determination of prostate cancer. The detection rate of prostate cancer is the highest , when puncture length per cubic centimeter of prostate is≥3.40 mm/cm3.

Objective To evaluate and compare the effectivity and safety of mini-percutaneous nephrolithotomy (mPNL) and flexible ureteroscopic lithotripsy (FURL) for diameter 10 to 20 mm renal stone in obese patients. Methods This was a multicenter prospective study. One hundred and ten obese patients (body mass index≥28.0 kg/m2) with diameter 10 to 20 mm kidney stone from January 2015 to May 2017 were selected. The patients were divided into mPNL group (58 cases) and FURL group (52 cases) according to the patients′ will. The operation time, hospitalization time, complication, one-stage stone removal rate and ultimate stone removal rate were compared between 2 groups. Results The operation time, hospitalization time and incidence of complication in FURL group were significantly lower than those in mPNL group: (66.7 ± 21.9) min vs. (85.7 ± 33.4) min, (72.5 ± 23.7) h vs. (120.8 ± 33.5) h and 9.6% (5/52) vs. 31.0% (18/58), and there were statistical differences (P＜0.05). There were no statistical differences in the one-stage stone removal rate and ultimate stone removal rate between 2 groups (P＞0.05). In aspect of postoperative bleeding, hemoglobin decreased after operation (15.8 ± 9.7) g/L in mPNL group; no hemorrhage occurred in FURL group, and no significant changes in hemoglobin were observed before and after operation. Conclusions Both mPNL and FURL achieve satisfactory stone-free rates in obese patients with diameter 10 to 20 mm renal stone. Compared with mPNL, FURL has shorter operation time and lower incidence of complication.

Objective To investigate the diagnostic accuracy of magnetic resonance imaging and ultrasound (MRI/US) fusion targeted biopsy (TB) and systematic biopsy (SB) in the patients with prostate specific antigen (PSA) in grey area.Methods The patients who received MRI/US fusion TB and SB in the First Affiliated Hospital of Soochow University between October 2015 and March 2018 were retrospectively reviewed.Eligibility criteria included:tPSA ranged 4 to 10 ng/ml;prebiopsy MRI found at least 1 suspected lesion;no prostate-related treatment history;no prostate biopsy history.A total of 93 patients were invloved.The median age,tPSA and prostate volume were 66 (30-85) years,7.18 (4.11-9.95) ng/ml and 42.01 (14.93-119.15) ml,respectively.Prebiopsy MRI found 136 suspected lesions,with the median PI-RADS of 3 (3-5) and lesion size of 7 (3-20) mm.All patients underwent MRI/US fusion TB followed by SB.The comparison of two protocols in detecting any prostate cancer (PCa) as well as clinically significant prostate cancer (CsPCa) were analyzed.Results Cancer detection rates for PCa in TB [34.40％ (32/93)] was not different with SB [36.55％ (34/93),P =0.759].There was no significant difference in the detection rate of CsPCa between TB and SB [20.43％ (19/93) vs.24.73％ (23/93),P=0.483].A total of 1 374 biopsy cores were sampled,among which 266 were TB cores and additional 1108 were SB cores.The positive rate of TB cores [24.81％ (66/266)] was significantly higher than SB cores [9.84％ (109/1 108),P ＜0.001].Conclusions In the patients with PSA in grey area,MRI/US fusion TB achieved similar cancer detection rate compared with SB using only few biopsy cores.Therefore,TB was appropriate for patients with MRI suspicions.Moreover,combination of TB with SB can achieve the highest cancer detection rate.

Objective To estimate the value of transrectal ultrasound/magnetic resonance imaging (TRUS/MR) fusion targeted prostate biopsy(targeted biopsy,TB) in the biopsy naive patients.Methods Between September 2015 and September 2016,91 patients with PI-RADS ≥ 3 suspicious regions on the multiparametric magnetic resonance imaging (mpMRI) were retrospectively evaluated.The age of patients was 46-83 years (median 68).Serum PSA level before biopsy was 1.2-85 ng/ml (median 11.2 ng/ ml),in which 36 cases with PSA ＜ 10 ng/ml,30 cases 10-20 ng/ml,and 25 cases ＞ 20 ng/ml.Two-core TB using real-time virtual sonography (RVS) platform for mpMRI-suspicious lesions was followed by 12-core systematic biopsy (SB).The detection rates for any cancer (PCa) and clinically significant prostate cancer (CsPCa) were compared between TB and SB.Results The total detection rate for PCa was 57.1％,with a comparable positive rate between TB (44.0％) and SB (51.7％) groups which did not significantly differ (P =0.14).The proportion of CsPCa in TB group was higher than that in SB group (80.0％ vs.68.1％,P =0.21).In TB group,detection of PCa for grade 5 lesions was significantly higher than that for grade 3 lesions (77.1％ vs.10.3％,P ＜0.001).Detection of PCa was comparable between TB and SB groups in different regions of PSA ＜ 10 ng/ml,10 ～ 20ng/ml and ＞ 20ng/ml (27.8％ vs.36.1％,50％ vs.56.7％,60％ vs.68％,respectively).Conclusions This study revealed a similar rate of prostate cancer detection between 2-core targeted biopsy guided by TRUS/MR fusion and 12-core random biopsy in different PSA regions for no prior biopsy men.TB maybe tend to detect high proportion of CsPCa.PI-RADS is instructive to select appropriate patients for TB.

Objective To evaluate the feasibility and efficacy of intra-cavity contrast enhanced ultrasound (ICCE-US) in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis.Methods From March 2016 to March 2017,ICCE-US-guided PCNL was performed in 35,patients who had kidney stones with slight hydronephrosis in 11 and without hydronephrosis in 24.The sample comprised 20 males and 15 females,including 10 with renal pelvic calculi alone,17 with renal pelvic calculi combined with renal calyx calculi,and 8 with partial staghorn calculi.Mean age was 46.8 years (ranging,28-75 years).The size of calculi ranged from 2.5 cm to 5.0 cm [mean(3.6 ± 1.2) cm].In the prone position,the preferred calyces are the posterior ones,which were enhanced by sulfur hexafluoride microbubbles (SonoVue) retrogradely injected through ureteral catheter.An 18-gauge needle was inserted toward the desirable calyx.Successful renal entry was confirmed by administration of ultrasound contrast agents into the collecting system via the needle regardless of whether spontaneous urine drainage was observed.A guidewire was passed through the needle to renal collecting system.Subsequently,the needle was removed.And the renal tract was dilated to F18-F20 size with dilators.Finally,holmium laser lithotripsy was performed through nephroscopy.Results Posterior calyces and its fornix were revealed under contrast-enhanced ultrasound in all patients.The successive access rate was 100％.The average time for establishing the access was (8 ±2.6)min (ranging 5-10 min).The mean number of needle passes was (1.5 ± 0.3) times per kidney,ranged from 1 to 3 times.Hemoglobin level averagely reduced (11.3 ± 3.7) g/ L (ranging 6-15 g/L) within 24 hours postoperatively.No major complications,such as adjacent organs injuries or collecting system perforation were observed.No blood transfusion was needed.The mean hospital stay was (5.6 ± 1.2) days (ranging 5-7 days).The stone-free rate was 91.4％ (32/35).Conclusions ICCE-US can demonstrate clearly about the posterior calyces and its fornix as well as puncture needle site by contrast enhancement in the nephrolithiasis patients with slight or no hydronephrosis.It has the potential to improve the accuracy and successive rate of puncture resulting in a decrease in the puncture-related complications.