Objective:To investigate the feasibility and accuracy of transperineal prostate targeted biopsy guided by holographic image.Methods:Clinical data of 10 patients with transperineal prostate targeted biopsy guided by holographic image in Peking University Shougang Hospital between May and September 2020 were analyzed retrospectively. The average age was (70.9±10.3) years old, the median PSA was 15.1(6.02-1110.14) ng/ml, prostate MRI were performed before biopsy and the PI-RADS scores were all ≥ 3, and the number of suspicious target lesions was 1.4±0.5. CT examinations of urinary system were performed on the premise of mild lithotomy position and positioning stickers pasted on the skin of perineum and lower abdomen. The original data of CT and MRI were obtained, holographic image models were firstly made separately and then fused into a complete model, and the puncture paths were planned for the target lesions. At the time of puncture, the patient took the same body position as in CT scan, the operator wore a mixed reality head mounted display (HoloLens glasses), and the skin positioning stickers were used for visual registration between the holographic model and the real human body. Then under the guidance of the virtual puncture path, the puncture biopsy gun was placed, fired after reaching the predetermined depth, a transrectal ultrasound probe was placed to clarify the position of the puncture needle, and the objective accuracy of puncture was judged by comparison of ultrasound and MRI images. If the first shot was judged to be inaccurate, it was allowed to make a supplementary shot after adjusting the angle. After holographic guided biopsies, cognitive fusion targeted biopsies and 12-needle systematic biopsies were performed routinely, and the proportion of positive needles of the three different biopsy methods were calculated respectively.Results:All the 10 cases were successfully completed, including 16 holographic image guided shots, 28 cognitive fusion targeted shots and 116 systematic shots. The objective accuracy of holographic image guided biopsy after first shot judgments was 68.8% (11/16), while it raised to 87.5% (14/16) after supplementary shots. The proportion of positive needles in the three puncture methods were 56.3% (9/16), 42.9% (12/28) and 19.8% (23/116), respectively ( P=0.002). The results of subjective questionnaire showed that holographic model was helpful to improve the spatial understanding of lesions. The satisfaction of intraoperative holographic registration and guided puncture were 90% and 60%, respectively. No puncture related complication occurred in this group. Conclusion:The study preliminarily confirmed the feasibility of holographic image-guided prostate targeted biopsy. This new puncture method has better objective accuracy, and the proportion of positive needles is significantly better than systematic biopsy.

Objective:To evaluate the clinical value of the holographic image and navigation in robotic assisted laparoscopic radical prostatectomy (RARP) .Methods:From Sept. 2020 to Dec. 2020, 5 patients diagnosed with prostate cancer in Beijing United Family Hospital were included in this study. The mean age was 57 years(38-69 years). Before the operation, the engineers established the holographic image based on the enhanced MRI images. The holographic images were used in pre-surgery planning. During the operation, the navigation was achieved by real time fusing holographic images with the robotic surgery endoscopic views. Some important structure such as prostate, bladder neck and the tumor could be observed and monitored in real time. The No.1 patient had high-risk prostate cancer, underwent RARP+ extended pelvic lymph node dissection; The No.2 patient had low-risk prostate cancer, underwent RARP, and the right side neurovascular bundle (NVB) was preserved; The No.3 patient had low-risk prostate cancer, underwent RARP, and the bilateral side NVB was preserved; The No.4 patient had low-risk prostate cancer, underwent RARP, and the right side NVB was preserved; The No.5 patient had high-risk prostate cancer, underwent RARP+ extended pelvic lymph node dissection, and the bilateral side NVB was preserved.Results:All the 5 cases surgeries were successful, no conversion to open surgery, the mean operation time was 161.7min (160-250min), the mean blood loss was 426.7 ml(60-1000 ml). The pathological results were pT 3bN 0 cM 0, pT 2aN 0 cM 0, pT 2aN 0 cM 0, pT 2aN 0 cM 0 and pT 3aN 1 cM 0, respectively. There was no over Clavien Dindo Ⅱ perioperative complications. 4 patient achieved continence when catheter removal. The PSA level and erectile function were monitored in the follow up. Conclusions:Holographic image navigation might have clinical value in RARP.

Objective To evaluate the clinical value of holographic image navigation in urological laparoscopic and robotic surgery.Methods The data of patients were reviewed retrospectively for whom accepted holographic image navigation laparoscopic and robotic surgery from Jan.2019 to Dec.2019 in Beijing United Family Hospital and other 18 medical centers,including 78 cases of renal tumor,2 cases of bladder cancer,2 cases of adrenal gland tumor,1 cases of renal cyst,1 case of prostate cancer,1 case of sweat gland carcinoma with lymph node metastasis,1 case of pelvic metastasis after radical cystectomy.All the patients underwent operations.In the laparoscopic surgery group,there were 27 cases of partial nephrectomy,1 case of radical prostatectomy,2 cases of radical cystectomy and 2 cases of adrenalectomy.In the da Vinci robotic surgery group of 54 cases,there were 51 cases of partial nephrectomy,1 case of retroperitoneal lymph node dissection,1 case of retroperitoneal bilateral renal cyst deroofing and 1 case of resection of pelvic metastasis.There were 41 partial nephrectomy patients with available clinical data for statistic,with a median age of 53.5 years (range 24-76),including 26 males and 15 females.The median R.E.N.A.L score was 7.8 (range 4-11).Before the operation,the engineers established the holographic image based on the contrast CT images and reports.The surgeon applied the holographic image for preoperative planning.During the operation,the navigation was achieved by real time fusing holographic images with the laparoscopic surgery images in the screen.Results All the procedures had been complete uneventfully.The holographic images helped surgeon in understanding the visual three-dimension structure and relation of vessels supplying tumor or resection tissue,lymph nodes and nerves.By manipulating the holographic images extracorporeally,the fused image guide surgeons about location vessel,lymph node and other important structure and then facilitate the delicate dissection.For the 41 cases with available clinical data including 23 cases of robotic-assisted partial nephrectomy and 18 cases of laparoscopic nephrectomy,the median operation time was 140 (range 50-225) min,the median warm ischemia time was 23 (range 14-60) min,the median blood loss was 80(range 5-1 200) ml.In the robotic surgery group,the median operation time was 140 (range 50-215)min,the median warm i schemia time was 21 (range 17-40)min,the median blood loss was 150(range 30-1 200)ml.In the laparoscopic surgery group,the median operation time was 160(range 80-225)min,the median warm ischemia time was 25 (range 14-60)min,the median blood loss was 50 (range 5-1 200) ml.All the patients had no adjacent organ injury during operation.There were 2 cases with Clavien Ⅱ complications.One required transfusion and the other one suffered hematoma post-operation.However,the tumors were located in the renal hilus for these 2 cases and the R.E.N.A.L scores were both 11.Conclusions Holographic image navigation can help location and recognize important anatomic structures during the surgical procedures..This technique will reduce the tissue injury,decrease the complications and improve the success rate of surgery.

Objective To investigate the effectiveness of Uromentor virtual reality simulator in flexible ureteroscopy training for catechumen.Methods Fifty-one catechumen were selected.After 1 hour training of basic operation in Uromentor virtual reality simulator, all trainees performed special-purpose exercise ( kidney inspection with flexible ureteroscopy ) for 3 hours. Using right kidney inspection, a preliminary assessment for each trainee was made before the special-purpose exercise and data such as total time, number of trauma from the scopes and tools, percentage of kidney surface examined and global rating scale ( GRS ) were recorded.The same assessment was performed once again after the special-purpose exercise ( secondary assessment ) , and data were recorded and compared to the preliminary assessment. Results Each trainee made a significant improvement in flexible ureteroscopic skill after the special-purpose training.The parameters such as total time, number of trauma from the scopes and tools, percentage of kidney surface examined and GRS of all trainees in preliminary assessment were 14.63 ±1.01 min, 8.62 ± 2.67, 51.05%±20.79%and 10.31 ±2.53, respectively;while in secondary assessment, parameters were 7.71 ±1.13 min, 1.67 ±1.23, 98.04% ±5.42% and 29.14 ±3.01, respectively.The differences between the preliminary assessment and the secondary assessment of each parameter were significant ( P<0.01).Conclusions The Uromentor virtual reality simulator can improve the trainee′s skills of flexible ureteroscopy.It is a good instrument of the flexible ureteroscopic training for catechumen.

Objective To investigate the efficacy of using three-dimensional (3D) printing technique on surgical planning and its function in enhancing the physician-patient rapport before surgery.Methods From June 2013 to January 2014,10 patients with T1 renal tumors,who were received laparoscopic partial nephrectomy,were selected in study.Left renal tumor was found in 3 cases and right renal tumor was found in 7 cases.The location of tumor included upper part of kidney in 5 cases,lower part of kidney in 3 cases and renal hilum in 2 cases,4 cases were diagnosed as T1a stage and 6 cases were diagnosed as T1b stage.64-slice enhanced CT scan was performed preoperatively.Data of DICOM format was sent for post processing.The final data was then output to 3 d printer for generating kidney models using thermoplastic plastics.After generating the model,different colors were put on the model,including pink in kidney,yellow in pelvis and ureter,red in renal artery and blue in renal vein.Plotted questionnaires were designed for medical professionals and patients,respectively.4 urological experts make the scores by this questionnaire in order to evaluate the efficacy and fidelity of the model.2 surgeons evaluated the efficacy of model after operation by comparing the actual tumor size with that measured on the models.Meanwhile,the model was used for conversation before operation.The questionnaires were also used for evaluating the effectiveness of conversion.Results 10 kidney models fabricated successfully with 3D-printing.The tumor size,position,renal vascular and collecting system could be clearly presented.Being evaluated by 4 experts and 2 performing urologists,and the mean scores was 7.8 ± 0.7.Intraoperative correlation was advocated by the performing urologists.The mean evaluation score was 7.5.The bias between real diameter of renal carcinoma and that of 3 d model was 3.4± 1.3 mm.Patients and family members preferred the demonstration of the disease and the procedure with a visual and tactilediseased organ.The scores of satisfactory were 9.0 ± 0.8.Conclusions The 3d printed model could exhibit the relationship between tumor and renal,clearly.It can help the urologists in making surgical plan,effectively.Patients' Understandings from patients and family members of the disease and the procedure to be used can be upgraded with this novel technology.

Objective To explore the appropriate time to block adrenal androgens in endocrine therapy of prostate cancer.Methods An human androgen-dependent prostate carcinoma xenograft model in SCID mice was established with LNCaP cells.Firstly,the serum PSA and tumor volume of 2 groups (castrated and not castrated) were measured on the 1,4,7,10,14,17,21,28,35,42,49 and 56 day to determine the recurrent time of prostate cancer after castration.Secondly,3 different groups of castration and adrenalectomy at the same time,adrenalectomy in recurrence after castration and sham adrenalectomy in recurrent after castration,were set to measure the serum PSA and tumor volume on the 1,4,7,10,14,17,21,28,35,42,49 and 56 day.The tumor tissues of 5 groups were harvested to measure testosterone concentration,and tumor progress in these groups was compared.Results The recurrence time was 14 days in castrated group,21 days in group with castration and adrenalectomy at the same time and 35 days in group with adrenalectomy in recurrence after castration.The testosterone concentration in tumor tissues was (2.69± 0.21) pmol/g in the group with castration and adrenalectomy at the same time,and (2.16±0.13) pmol/g in the group with adrenalectomy in recurrence after castration,and the difference was significant (P＜0.05).Conclusion Compared with the therapy of castration and adrenalectomy at the same time,the therapy of adrenalectomy in recurrence after castration may have slower progress course in prostate cancer.

Background and purpose:Laparoscopic partial nephrectomy has been one of the surgery options for patients with single renal carcinoma of T1 stage. Under the effect of some factors, intraoperative renal blood lfow clamping somtimes exceeds the safe limit of 30 minutes of warm ischemia time (WIT) for renal tissues, that might results in warm ischemia-reperfusion injury to severe extent. However, there still remains controversy about the depth of this warm ischemia-reperfusion injury. So this study aimed to evaluate the effects of longer WIT on ipsilateral residual renal tissues. Methods:Forty-four patients underwent retroperitoneal laparoscopic partial nephrectomy from Jan. 2012 to Jan. 2014. All of them were divided into observe group (WIT>30 min) and control group (WIT≤30 min). The differences of glomerular filtration rate (GFR) of operative kidney Pre- and post-operatively between two groups were analyzed. Results: The pre- and post-operative GFRs of operative kidney in observe group were 29.3-53.0 mL/min[(33.1±5.2) mL/min], 23.1-40.5 mL/min[(27.3±5.9) mL/min] respectively (P=0.054). The pre-and post-operative GFRs of operative kidney in control group were 27.4-49.6 mL/min[(32.3±4.1) mL/min], 23.8-44.4 mL/min[(29.1±5.0) mL/min], respectively (P=0.07). There was no statistically differences of the depth of the decrease of GFRs after surgery between the two groups (P=0.051). Conclusion: WIT of 30-60 min does not result in statistically signiifcant injury for ipsilateral residual renal function. However, it is still necessary to reserve more ipsilateral residual renal function through minimizing WIT under the premise of ensuring the safety of surgery.

Objective To set up the methods of establishing rat primary benign prostatic hyperplasic glandular epithelial cell line.Methods Male spontaneously hypertensive rats were raised to 29 weeks,and then evaluated the situation of BPH with HE staining.The prostate tissue from ventral prostate lobe was aseptically removed,dissected,minced,and then dissociated in collagenase type Ⅰ.Isolated cells were collected,seeded in WAJC-404 and PrEGM medium separately,then cultured and passaged.Specificity of primitive cultured prostatic epithelial cells was identified by cell immunochemistry with CK8/18,and the cell growth curves were drawn.Then the situation of growth of the two prostatic hyperplasic glandular epithelial cell lines were analysed and compared.Results The prostatic hyperplasic glandular epithelial cell lines of the spontaneously hypertensive rats in WAJC-404 and PrEGM medium were successfully primarily cultured,purified and passaged in vitro.Cell immunochemistry proved that the cell lines specifically express cytokeratin 8/18.Cell growth curve showed that prostatic epithelial cells in PrEGM,compared with prostatic epithelial cells in WAJC-404,possessed better cell morphology,more exuberant cell vitality,faster growth rate to enter the logarithmic growth period(4 d vs.7 d)and higher peak of cell growth curve(15.3× 104/ml vs.12.8×104/ml).Conclusions Rat primary benign prostatic hyperplasic glandular epithelial cell line can be established conventionally in vitro.PrEGM medium is more suitable for primary culture of the rat benign prostatic hyperplasic glandular epithelial cell line than WAJC-404 medium.

Objective To compare the safety and clinical efficiency between minimally invasive percutaneous nephrolithotomy(MPCNL)in supine position and flexible ureteroscopy(FURS)in management of proximal ureteral calculi.Methods From Oct.2010 to May.2012,76 patients with single proximal ureteral calculus between 10-20 mm failed in SWL or other conservative therapy accepted MPCNL (32 cases)or FURS(44 cases).There was no significant difference between the groups in base-line parameters.Stone sizes were(15.6±2.5)mm and(14.9±2.3)mm,P＞0.05.Procedural time,post-operative hospitalization stay,complication rates(Clavien degree Ⅱ or over)and stone free rates were compared.Results In these two groups,procedural time was(49.3± 11.7)and(67.2± 17.3)min,P＜0.05,postoperative hospitalization stay were(4.2±1.1)and(1.8±0.8)days,P＜0.05,complication rates were 12.5％ and 6.8％,P＞0.05 and stone free rates(residual fragments≤3 mm)were 93.7％ and 84.1％,P＞0.05.Conclusions For patients with surgically indicated proximal ureteral calculi,both minimally invasive percutaneous nephrolithotomy in supine position and flexible ureteroscopy are effective and safe therapeutic modalities.Patients treated with flexible ureteroscopy have faster postoperative recovery.

Objective To evaluate the effect of pregnancy and delivery after renal transplantation (RT)on recipients,graft and offspring.Methods Clinical data of 6 pregnancies in 5 recipients were retrospectively studied and literature was reviewed.Results Among them,6 pregnancies and 4 deliveries occurred in 5 female RT recipients.The mean age at pregnancy was 31.1 years,with a mean interval between RT and pregnancy being 3.6 years.Preeclampsia developed in two pregnancies and hyperlipemia in one pregnancy.One RT recipient who discontinued immunosuppressant following pregnancy on her own exhibited subsequent renal failure.She underwent a second RT and delivered a healthy baby two years following the second RT.One RT recipient decreased the immunosuppressant dose to half after the pregnancy on her own and developed renal failure thereafter.Four patients underwent a Cesarean section at 38 th,35 th,35 th,and 38 th week,respectively.The mean birth weight was 3262.5 g with all Apgar scores of 10.Conclusion Our data coupled with prior reports suggest that for the recipients with normal renal function,successful pregnancy is achievable if immunosuppressant was taken correctly,but the pregnancy is at high risk,and careful monitoring is needed.