In recent years, the incidence of single-gene nephrolithiasis has been increasing year by year. With the application of whole-genome analysis and whole-exome sequencing technology, the etiology of single-gene mutations leading to the development of urinary calculi has been extensively verified. Therefore, this article reviews the research on urinary calculi-related genetic diseases at home and abroad, and introduces transport proteins and channels; ions, protons and amino acids. The role of urinary calculi in the majority of clinicians realizes the significance of genetic testing in such diseases, thereby increasing the understanding of genetically related urinary calculi and improving the level of clinical diagnosis and treatment.

Benign prostatic hyperplasia (BPH) is a slowly progressing benign disease. Some patients still have to receive operation. If surgical treatement time is not proper, it may increase the risk of operation and reduce therapeutic effect. However, there is still lack an effective method to evaluate the optimal timing of BPH surgery. The large-scale, multi-center, high-quality clinical trials are needed to clarify the reasonable solutions.

Objective To summarize the preliminary experience of extraperitoneal laparoscopic radical prostatectomy (C.R.P.C.four-step) for localized prostate cancer and the outcomes based on early follow-up.Methods A total of 102 prostate cancer patients were screened by prostate specific antigen (PSA) and diagnosed by prostate magnetic resonance imaging and prostatic puncture biopsy with cT1c-cT3b,with average age of (67 ±5) years old,average preoperative total PSA value of (45.32 ± 18.33) ng/ml,and average prostate volume was (42 ± 12)cm3.All these patients underwent extraperitoneal laparoscopic radical prostatectomy by the four-step technique,abbreviating as C.R.P.C.[C:control DVC (dorsal deep venous complex).R:recognize three anatomical layers (prostate and bladder junction,seminal vesicle,and Denonvilliers' fascia surface).P:preserve urethral sphincter and bladder neck.C:continuous anastomosis between urethra and bladder neck (4 key needles at 3,5,7 and 9 o'clock)].The operative time,estimated blood loss,length of hospital stay and postoperative complications were recorded,and the postoperative PSA was followed up.Results All the 102 cases were successfully treated by iaparoscopic radical prostatectomy.The operative time was from 55 to 156 min (mean 92 min),and the estimated blood loss was from 55 to 185 ml (mean 105 ml).There was no case converted of open surgery,only one case received blood transfusion for postoperative hemorrhage (0.98％),and positive surgical margin was found in 15 case (14.70％) by pathological examination.Postoperative urinary extravasation within one week occurred in 2 (1.96％) cases,and resolved after tensioning the catheter and prolonging the indwelling time.During the follow-up period of 12 to 45 months,2 cases were incontinent (grade I-II),and the other cases(98.04％) had no incontinence or dysuria.However,11 cases (10.78％) developed to biochemical recurrence within 6 months after the operation.Conclusions The C.R.P.C.four-step technique of lparoscopic radical prostatectomy is easily to be grasped and performed by the greenhand urologists,and was efficient and safe.

In December 2019, a novel coronavirus pneumonia (COVID-19) epidemic occurred in Wuhan and spread to many countries and regions around the world. In order to better enhance the pertinence and effectiveness of prevention and control method of COVID-19 during daily urological practices, we drew up this detailed suggestion based our previous successful work experiences in Wuhan.

Objective To evaluate the pathological stage,the presence of detrusor muscle and the clinical significance for standardized examination of specimens for en bloc transurethral resection technique with Hybrid Knife to treat NMIBC (ERBT) compared with conventional TURBT.Methods This was prospective randomized controlled study.This study was approved by the Ethics Committee of Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology (TJ-IRB20180604),and patients all signed informed consent.The clinical study registration number of this study:NCT03221062.The margin of the tumor was recognized and marked by with Hybrid Knife (0.5 cm away from the normal mucosa).Then water was injected into the submucosa and form a water pad,with a circular cutting layer by layer (0.5 cm away from the marked position),reaching the detrusor muscle in depth.After complete resection,the tumor was removed by specimen bag.Specimens for ERBT cohort were given standard handling.Resected specimen of ERBT stretched with pins on foam and its margin was stained.The basement of specimen was also stained.Total specimen sectioned into appropriate pieces for histological assessment in the department of pathology.TURBT cohort performed traditional surgical methods and pathological examination.All patients received postoperative intravesical instillation according to their pathology.Imaging and cystoscopy were performed every 3 months.The primary study end-point was the quality of resection,including the pathological stage and the presence of DM.Secondary outcomes were:short-term tumour recurrence rate (18 month),feasibility,and safety.Results From January 2017 to October 2017,109 patients were enrolled.51 patients underwent ERBT,and 58 patients underwent TURBT.The clinical characteristics of the patients in each cohort,such as average age,gender,average BMI,smoking history,the mean number of lesions and tumour size had no significant differences (P ＞ 0.05).The operation of 109 cases was completed successfully.There was no statistical difference between the operative time and the postoperative bladder irrigation time.Major intraoperative or postoperative complications (Clavien ≥ Ⅱ) did not occur in all of the patients.The percentage of T1 staging was higher in the ERBT cohort vs.TURBT cohort [21/51 (41.2％) vs.13/58 (22.4％),P =0.035],of which ERBT cohort accurately detected 9 cases (42.8％) of T1b patients,significantly higher than TURBT cohort (2 cases,15.4％) (P =0.096).All the ERBT samples showed the presence of DM (100.0％),while there was only 77.4％ in TURBT cohort (P ＜ 0.05).Mean follow-up (20.3 ± 3.1) months (ranged from 18 to 24 months).Recurrence rate were 8.9％ (4/45) in ERBT cohort vs.22.2％ (12/54) in TURBT cohort (P=0.059).Conclusions ERBT with Hybrid Knife for treatment NMIBC is a safe,effective,and provides high-quality specimens compared to TURBT.More high-risk NMIBC patients,especially T1 b patients,can be detected obviously by pathologist with the standardized treatment of specimens.

The aetiology of hematuria from upper urinary tract is sophisticated including benign and malignant lesions. With comprehensive utilization and improvement of flexible ureteroscopy(fURS), especially innovation and elaboration of digital fURS with auxillary armaments, it may present qualitative as well as localized evidence for etiological diagnosis of hematuria from upper urinary tract. Based on the precise decision of individual strategy, flexible ureteroscopic laser ablation gradually turns to be a direction and trend of option in selected cases based. Flexible ureteroscopy plays a critical role in the diagnosis and treatment of hematuria from upper urinary tract.

In recent years,brilliant achievements have been made in the field of urolithiasis treatment in China.A large number of multicenter or prospective clinical trials have been accomplished and transformed.Clinical application of enormous equipment and instruments with independent intelligent property right as well as lots of de novo clinical techniques have been carried out and introduced to the world,which have greatly narrow down the gaps between our country and the most developed countries in the world.However,while the rapid development like a hundred flowers in bloom,we should also clearly know that standardization are still insufficient in the field of urolithiasis treatment,some of which will result in severe problems.In current review,status quo of nowadays urolithiasis treatment is analyzed and sumnarized in order to further standardize clinical techniques and plan the direction of the future in this area.Based on these consideration,implement solutions,improvements and the ideas of establishment of the integrated treatment unit for urinary calculi as a future direction are proposed accordingly.

Objective To investigate the causes of bleeding due to arterial injury after minimally invasive percutaneous nephrolithotomy (mPCNL).Methods We retrospectively analyzed the clinical data of 2 980 patients who underwent ultrasound-guided mPCNL between January 2012,and January 2017,in our hospital.Among them,1 853 were male and 1 127 were female.Age from17 to 76 years old,average age was (45.7 ± 24.1) years.The calculi size was from 1.5 to 4.2 cm,average of (2.62 ± 1.08) cm.There were 2 478 kidney stones and 502 cases of ureteral calculi.Besides,727 cases with mild hydronephrosis,1 971 cases with moderate hydronephrosis,282 cases with severe hydronephrosis;480 patients with urinary tract infection;103 patients with renal empyema or acute renal failure;63 patients with cardiovascular and cerebrovascular stent implantation;214 patients with diabetes mellitus.Results In this study,all of the patients were established percutaneous renal tract successfully,indwelling drainage tube (6 ± 2)d,and postoperative hemorrhage in 117 cases,of which 29 patients suffered from bleeding due to arterial injury and DSA showed 20 cases with acute arterial injury,5 cases with pseudo-aneurysm,and 4 cases with arteriovenous fistula.However,all these cases were rehabilitated after the treatment of super-selective renal artery embolization.The rates of arterial injury of renal calyx access and pelvic access were 0.39％ (10/2 535) and 4.27％ (19/445),respectively.The rate of arterial injury in renal pelvic access was significantly higher than renal calyx access of PCNL (P ＜ 0.05).The rates of arterial injury in lower,middle,upper calyx access were 0.38％ (1/267),0.40％ (6/1 516),0.40％ (3/752),respectively.There was no significant effect of different renal calyx on postoperative arterial injury rate of mPCNL(P ＞0.05).All the percutaneous renal accesses were dilated with Amplatz sheaths,and the arterial injury rate of F16-18 and F20-22 tracts in the calyx access were 0.35％ (5/1 446),0.46％ (5/1 089),respectively,with no significant difference in size of calyx access associated with rate of arterial injury after mPCNL(P ＞0.05).The arterial injury rates of F16-18 and F20-22 tracts in the pelvic access were 1.98％ (5/253) and 7.29％ (14/192),respectively.There was significant difference in the size of the pelvic access in the rate of arterial injury after mPCNL(P ＜ 0.05).In addition,the arterial injury rate of single tract PCNL was 0.94％ (25/2 653) as compared to 1.22％ (4/327) in multi-tracts PCNL.There was no significant difference in the rate of arterial injury between single and multi-tracts PCNL(P ＞ 0.05).Conclusions The puncture of the renal pelvis and size of renal pelvis tract significantly increased the probability of postoperative bleeding due to arterial injury.

Objective To evaluate the prognostic value of the ratio of AR and AR-V7 expression in prostate cancer treated by castration therapy.Methods Immunohistochemical staining was performed in biopsy specimen of 136 prostate cancer patients received hormone therapy in Tongji Hospital of Huazhong University of Science and Technology from January 2010 to December 2015.Expression was determined using modified H score method.Patients aged from 53-96,the median age was 71,median tPSA value at diagnosed was 110.00 ng/ml(2.61-4 003.4 ng/ml),median fPSA value was 14.62 ng/ml(0.12-640.19 ng/ml),median PSA density was 1.15 ng/(ml · cm3) [0.02-62.63 ng/(ml · cm3)].Among these,88 (64.7％)patients were diagnosed Gleason score≥8,39(28.7％) patients with Gleason score 7,while 7 (6.6％) patients Gleason score ＜7.There were 54(39.7％) patients diagnosed T4 stage,57(41.9％)patients T3 stage and 25 (18.4％) patients Tx stage;62 (45.6％) patients were diagnosed N 1 stage,46 (33.8％) N0 stage and 28(20.6％) patients Nx stage;97(71.3％) patients were diagnosed M1 stage,30(22.1％) M0 stage,9 (6.6％) patients Mx stage.Cause-specific Cox regression and Kaplan-Meier Analysis were used to analyze the prognosis risk.Results The median follow-up time was 44 months,ranged 15-71 months.During the surveillance,the disease progression-free survival time ranged from 5-59 month,median 19 months.The overall survival time ranged from 12-61 months,median 31 months.Among these,79(58.1％) patients were AR positive and 26(19.1％) patients were AR-V7 positive,while AR and AR-V7 expression had no significant correlation (Spearman-test r =0.042,P =0.629).The AR-V7 positive patients showed significantly lower CRPC progression free survival (10.8 months vs.25.0 months,P ＜ 0.001) and much lower overall survival (20.3 months vs.42.8 months,P ＜ 0.001).The high AR-V7/AR expression ratio group showed significantly lower CRPC progression free survival (12.0 months vs.24.8 months,P ＜ 0.001) and much lower overall survival (22.5 months vs.42.8 months,P ＜ 0.001).In univariate Cox regression analyses,Gleason score at diagnosis,T stage,tPSA,PSA density and high AR-V7/AR expression ratio could predict the prognosis of hormonal therapy.While in multivariate Cox regression analyses,T stage(HR =2.597,95％ CI 1.351-4.995,P =0.004) and high AR-V7/AR expression ratio(HR =5.788,95％ CI 2.530-13.242,P ＜ 0.001) could effectively and independently predict the prognosis of hormonal therapy.Conclusion High AR-V7/AR HS ratio is the independent predictor of the prognosis of prostate cancer hormone therapy.AR-V7 positive and high AR-V7/AR HS ratio patients may have shorter PFS and overall survival time than AR-V7 negative and low AR-V7/AR HS ratio patients.

Objective Using Wisconsin Stone Quality of Life questionnaire (WISQOL) to compare standard percutaneous nephrolithotomy(PCNL) and tubeless PCNL.Methods From January 2017 to June 2017,patients who met the criteria (no urinary tract infection,stones between 1-3 cm,hydronephrosis larger than 3cm,renal cortex thickness ＞ 2 cm and without serious heart,lung,liver and kidney dysfunction and coagulation dysfunction) and underwent PCNL were prospectively enrolled and randomized into 2 groups,standard PCNL group and tubeless PCNL group.Diclofenac sodium suppositories were used to relieve pain in all patients with obvious pain.The quality of life of these patients were estimated and compared by using WISQOL.Safety and efficacy were also estimated.Result At the end of the study,a total of 50 patients were included in the analysis.There were 24 patients in the standard PCNL group and 26 patients in the tubeless PCNL group.There were 9 male patients in the standard PCNL group and 17 male patients in the tubeless PCNL group.There was no significant difference in gender between the two groups.The differences between the standard PCNL group and tubeless PCNL group in mean age (yrs.) [(53.21 ±13.35) vs.(51.1 ± 11.5),P =0.55],stone diameter (mm) [(18.46 ± 5.58) vs.(18.75 ± 5.39),P =0.85],stone-free rate (23/24 vs.24/26,P =0.60),mean hemoglobin decline (g/L) [(11.87 ± 9.20)vs.(10.43 ± 8.49),P =0.56] were not significant.Mean dosage of acesodyne(pcs) in tubeless PCNL group (4.07 ± 1.49) was significantly less than that in standard PCNL group (7.54 ± 2.23).There were no patient need transfusion or postoperative fever management.The influence of perioperative quality of life of patients treated with tubeless PCNL is significantly better than those treated with standard PCNL in 16 items which includ energy,sleep,work and family,physical symptoms,concerns related to intimacy and travel,and general emotional well-being.Conclusion Tubeless PCNL can improve patients' quality of life compared with standard PCNL.