Complex urinary stones have been the focus and difficulty of clinical treatment.Traditional multi-channel percutaneous nephrolithotomy (PCNL) has a high stone-free rate and efficacy in the treatment of multiple or large volume kidney stones，but has risk of serious complications such as bleeding and injury.Retrograde intrarenal surgery (RIRS) has been preferred in the treatment of renal stones with a diameter of less than 2 cm due to its characteristics of small trauma and fast recovery.However，it is difficult to treat small calyx stones with poor anatomy，lower renal calyx stones with small IPA，and diverticulum stones.Needle-perc assisted endoscopic surgery (NAES) includes the following modes：①Needle-perc plus PCNL，which can effectively reduce the number of channels，reduce surgical risks，and protect kidney function while ensuring a high stone-free rate; ②Needle-perc plus RIRS，which can significantly improve the success rate and stone-free rate without increasing kidney damage，thus having significant advantages in dealing with complex urinary stones.In order to popularize and promote this technique，this essay will review the relevant domestic and foreign literature and the clinical experience of our center，focusing on the indications，usage specifications，operative skills and precautions of NAES.

Benign prostatic hyperplasia (BPH) is one of the most common diseases in elderly men，and surgical treatment is one of the major therapeutic modalities.The management of prostatic hyperplasia nodules，especially capsular embedded hyperplasia nodules，is crucial to reduce the incidence of postoperative complications and rate of secondary surgery.In this essay，we summarize the sources of prostatic hyperplasia nodules，relationship between incidence of postoperative complications and capsular embedded hyperplasia nodules，advantages and disadvantages of various surgical procedures for the management of hyperplasia nodules and share our experience in the management of capsular embedded hyperplasia nodules in thulium laser enucleation of the prostate.

Urinary control in females is a complex physiological process.From an anatomical perspective,this article explores the role of static urethral anatomical changes and dynamic functional anatomical changes in the occurrence of female stress urinary incontinence (SUI).In SUI patients,the changes in the urethra include mucosal atrophy,reduced elasticity,sphincter dysfunction,and shortening of the functional urethral length.The surrounding supportive structures involved in the development of SUI include weakened bladder neck support,damage to the hammock structure,weakened pubic urethral ligament and dysfunction of the levator ani muscle.Additionally,damage to the pelvic floor nerve plays an important role in the pathophysiology of SUI.In terms of dynamic functional anatomy,this article analyzes three dynamic interlocking mechanisms,including the interlock between the bladder neck and pelvic diaphragm,the external urethral sphincter and levator ani muscle,the posterior urethra and perineal body.Through these dynamic mechanisms,the static structure is coordinated and supported,helping to maintain normal urinary control function.These analyses aid in understanding the mechanisms underlying urinary control problems in SUI patients.In summary,this article attempts to construct a clear theoretical framework for the clinical diagnosis and treatment of female SUI by systematically analyzing the static and dynamic factors of female urinary control mechanisms.

Objective: To analyze the relationship between asthma and nocturia in women based on the National Health and Nutrition Examination Survey (NHANES) database from 2005 to 2018,so as to provide reference for the prevention and treatment of female nocturia. Methods: Female respondents aged ≥20 years with nocturia or asthma were selected from the 2005-2018 NHANES database.Those with both diabetes stroke and obstructive sleep apnea syndrome were excluded.A weighted analysis was conducted using a complex sampling design.The association between asthma and nocturia in women was evaluated with univariate analysis，propensity score matching (PSM)，and multivariate logistic regression models. Results: A total of 14 718 respondents were selected，of whom 1426 (9.7%) were diagnosed with asthma，and 4664 (31.7%) with nocturia.There is a significant correlation between asthma and nocturia (χ =39.846，P<0.01). Age，body mass index (BMI)，smoking and race were also associated with nocturia (P<0.01).Multivariate logistic regression analysis showed that，the age，BMI，smoking，race and asthma were correlated with the risk of nocturia，before PSM matching (P<0.05).To eliminate confounding bias，PSM was applied，and generalized linear mixed model analysis after matching showed that the risk of nocturia remained high in asthma patients (OR=1.540，95% CI：1.320-1.800，P<0.01). Conclusion: Asthma is associated with nocturia in women，indicating that it may be an important risk factor for female nocturia.

Objective: To analyze the risk factors leading to infection after prostate biopsy，establish a nomogram prediction model and verify it. Methods: Clinical data of 523 patients who underwent ultrasound-guided prostate biopsy at our hospital during Jan.2023 and Jul.2024 were retrospectively analyzed.Patients were divided into an infection group and a non-infection group.Independent risk factors for infection after prostate biopsy were identified with univariate and multivariate binary logistic regression analyses，and a nomogram prediction model was constructed，which was validated with receiver operating characteristic (ROC) curve，calibration curve，and decision curve analysis (DCA). Results: Infection occurred in 54 cases (10.3%).Univariate and multivariate logistic regression analyses showed that age >65 years (OR=3.535，P=0.003)，diabetes (OR=5.693，P<0.001)，hypoproteinemia (OR=8.936，P<0.001)，preoperative urinary tract infection (OR=6.153，P<0.001)，puncture needles >12 (OR=4.347，P<0.001)，and transrectal puncture (OR=3.701，P<0.001) were independent risk factors for infection.Based on the multivariate logistic analysis results，a risk prediction nomogram model was constructed，with an area under the ROC curve (AUC) of 0.894.The calibration curve and DCA both indicated that the model had high predictive accuracy and clinical decision-making efficiency. Conclusion: Age >65 years，diabetes，hypoproteinemia，preoperative urinary tract infection，puncture needles >12，and transrectal puncture are independent risk factors for infection after prostate biopsy.The nomogram prediction model based on these factors helps identify high-risk patients，thereby enabling individualized treatment plans to reduce the incidence of infection.

Objective: To explore the safety and feasibility of the disconnection of the left renal artery preferentially during robot-assisted inferior vena cava (IVC) thrombectomy for patients with left renal cell carcinoma and tumor emboli. Methods: Clinical data of 7 patients who underwent robot-assisted IVC thrombectomy and radical nephrectomy in the First Affiliated Hospital of Zhengzhou University during Dec.2021 and Oct.2024 were retrospectively analyzed.Thrombectomy was performed first，followed by nephrectomy. The “IVC-first, kidney-last”robotic technique was developed to minimize chances of IVC thrombus. When patients in left lateral decubitus position, the left renal artery was severed from the right side through the inferior vena cava and abdominal aorta. After removal of thrombus from IVC was completed, patients changed to the right lateral position to complete radical left nephrectomy. Results: Imaging examinations revealed that the median diameter of the renal cell carcinomas was 83(46-99) mm; the median length of the inferior vena cava cancerous emboli was 49(2-91) mm.According to the Mayo classification，the cancerous emboli were gradeⅠ in 2 cases，gradeⅡ in 4 cases，and grade Ⅲ in 1 case.All surgeries were successful.The median operation time was 248(201-331) minutes，blood loss 500(200-1000) mL，and 6 cases required intraoperative blood transfusion.The median time for transition into the intensive care unit was 1(1-4) days，and drainage tube removal 6(5-12) days.Serum creatinine increased significantly in 5 cases，4 of which returned to normal after 1 week，but 1 had renal insufficiency (creatinine 166 μmol/L).Chylous fistula occurred in 1 patient，and lower extremity venous thrombosis developed in 3 patients.Pathological examinations indicated 6 cases of renal cell carcinoma and 1 case of MiT family translocation renal cell carcinoma.During the median follow-up of 17(1-35) months，5 cases were tumor-free，while 2 had lung and retroperitoneal metastases.They received targeted therapy of axitinib combined immunotheraphy and lived with tumors. Conclusion: In the left lateral position for left renal cell carcinoma with cancerous emboli，robot-assisted laparoscopic thrombectomy by crossing the inferior vena cava and abdominal aorta and disconnecting the left renal artery first is safe and feasible.

Objective: To explore the efficacy and surgical techniques of ultrasound-assisted transurethral flexible ureteroscopic holmium laser incision and internal drainage in the treatment of special renal cystic diseases，so as to provide reference for the diagnosis and treatment of such diseases. Methods: The clinical data of 48 patients with special renal cystic diseases treated during Jan.2019 and May 2023 were retrospectively analyzed.The diagnosis was made by computed tomography urography (CTU) and three dimensional urinary tract reconstruction before operation.All patients received the abovementioned surgery in semisupine lithotomy position.The general information，clinical data，and incidence of complications were analyzed. Results: There were 27 males and 21 females，with an average age of (48.0±7.5) years，including 22 cases of parapelvic cysts，6 cases of endogenic simple renal cysts with an average diameter of (5.0±1.0) cm，and 20 cases of renal calyceal diverticulum with stones，with an average diameter of (2.5±1.3) cm for the diverticulum and an average diameter of (1.5±1.0) cm for the stones，which were located in the upper or middle calyces.In 7 cases，ureteroscopic localization was difficult，and the surgery was completed with percutaneous renal puncture needle assisted localization.Ureteral stenosis was detected in 2 cases during surgery，and surgery was performed 4 weeks after double J tubes were placed.The remaining operations were successfully completed.The average operation time was (42.0±14.5) minutes，and average hospital stay was (2.0±0.5) days.During the follow-up of (12.0±8.5) months，lumbar pain improved in 27 cases (100%)，renal cysts disappeared in 23 cases (82.1%,23/28)，cysts significantly reduced by ≥50% in 4 cases (14.3%,4/28)，slightly reduced by <50% in 1 case (3.6%,1/28)，and the renal calyx diverticulum disappeared in 20 cases (100%).Gross hematuria and lower back pain occurred in 2 cases，and no other complications developed. Conclusion: Ultrasound-guided transurethral flexible ureteroscopic holmium laser incision and internal drainage is a safe and effective treatment for special benign renal cystic diseases.When ultrasound-guided flexible ureteroscope localization is difficult to perform，percutaneous renal puncture needle may be applied.

Objective: To investigate the efficacy and safety of robot-assisted modified Y-shaped ileal orthotopic neobladder reconstruction，so as to provide reference for clinical practice. Methods: The clinical data of 44 patients who underwent robot-assisted laparoscopic radical cystectomy，lymph node dissection，and modified Y-shaped ileal orthotopic neobladder reconstruction during Feb.2020 and Aug.2022 were retrospectively analyzed.The surgical position，Trocar position，and key surgical steps were reported.The perioperative conditions，postoperative complications，neobladder volume，maximum urinary flow rate，postvoid residual，renal function，and urinary control function were recorded. Results: All 44 surgeries were successfully completed，with operation time of (314.32±51.02) min，modified Y-shaped ileal orthotopic neobladder reconstruction time of (103.52±9.56) min，and bleeding volume of (128.18±57.27) mL.The postoperative time for fluid intake was (4.16±0.86) days，catheter indwelling time was (14.02±3.20) days，and patients were discharged 1 to 2 days after catheter removal.Clavien-Dindo grade Ⅱ and Ⅲ complications occurred in 15 and 2 patients，respectively.During the follow-up of (20.77±5.90) months，dysuria occurred in 1 case，urethral calculi in 2 cases，and incomplete bowel obstruction in 2 cases. The postoperative neobladder capacity was (195.75±15.51) mL，maximal urinary flow rate (20.30±2.05) mL/s，postvoid residual (19.86±13.80) mL and serum creatinine (81.98±25.97) μmol/L. The incidence of daytime and nocturnal urinary incontinence 3，6 and 12 months after operation were 20.45% and 29.55%，11.36% and 18.18%，and 4.55% and 9.09%，respectively. Conclusion: Robot-assisted modified Y-shaped ileal orthotopic neobladder reconstruction has favorable efficacy and safety，and low incidence of postoperative complications，which can be applied in clinical practice.

Objective: To explore the efficacy of focal radiofrequency ablation (RFA) in the treatment of low-to-intermediate risk localized prostate cancer and its impact on postoperative urinary control and sexual function recovery，in order to explore the feasibility of minimally invasive methods for the treatment of localized prostate cancer. Methods: Clinical data of 28 patients with low-to-intermediate risk localized prostate cancer who underwent RFA in Nanjing Drum Tower Hospital，Affiliated Hospital of Medical School during Jun.2017 and Feb.2021 were retrospectively analyzed.The 5-year failure-free survival (FFS) rate，surgery related complications，postoperative urinary control and sexual function were collected.The differences between the survival curves of patients in the low-risk and intermediate-risk subgroups were assessed with log-rank test and Breslow test. Results: All surgeries were successfully completed under local anesthesia.During the median follow-up of 43 (40-49) months，the 5-year FFS rate predicted by Kaplan-Meier method was 78.57%; 25 patients (89.29%) did not experience surgery-related complications; 27 patients (96.43%) were able to control urination; 1 patient developed new-onset sexual dysfunction.There was no significant difference in the survival curves between patients in the low-risk and intermediate-risk groups (P>0.05). Conclusion: RFA for patients with low-to-intermediate risk localized prostate cancer has good clinical efficacy，little impact on urinary control and sexual function recovery，and few postoperative complications，which can be used as one of the treatment options for these patients.

Objective: To evaluate the clinical efficacy and safety of micro-percutaneous nephrolithotomy (microPCNL) using Needle-perc in the oblique supine-lithotomy position for treating 1—2 cm lower-pole stones (LPSs)，by comparing it with flexible ureteroscopic lithotripsy (FURL)，so as to identify an effective surgical method for LPSs. Methods: We retrospectively analyzed the clinical data of 56 patients with isolated LPSs of 1—2 cm treated in our hospital during Jan.and Dec.2023.Patients were divided into two groups based on the treatment method：FURL (n=31) and microPCNL (n=25).General information and perioperative data were compared between the two groups. Results: All operations were successfully completed.The operation time was shorter in the microPCNL group than in the FURL group \[(46.5±10.1) min vs.(73.5±18.9) min，P<0.001\].Stone-free rate (SFR) was 92.0% in the microPCNL group and 71.0% in the FURL group (P=0.026).There were no significant differences in the average fall of hemoglobin level，serumc creatinine change level，hospitalization time and postoperative fever between the two groups. Conclusion: MicroPCNL in oblique supine-lithotomy position is a safe and effective treatment for 1-2 cm LPSs，with a higher SFR compared to FURL.