There are various complicated wired connections in traditional endoscopic systems, which have disadvantages such as prolonging the preoperative setup time, restricting the movement of laparoscope, hindering the intraoperative manipulation, potentially contaminating the operation area and causing safety hazards.Our team has developed a wireless intelligent ultra-high-definition endoscopic system for the first time, which has been widely applied in many urological surgeries, such as tumors, stones, transurethral prostate enucleation, laparoscopic pyeloureteroplasty, laparoscopic renal cyst top decompression and so on.This essay reviews the applications and advantages of this system in urology, and forecasts its prospects.

Objective To investigate clinical characteristics and risk factors of different stages of urinary tract infection after kidney transplantation.Methods Clinical data of 209 kidney transplant recipients were retrospectively analyzed.According to time points of postoperative follow-up,all recipients were divided into 3 stages:within 1 month post-kidney transplantation,1-6 months post-kidney transplantation,and 7-12 months post-kidney transplantation.The incidence of urinary tract infection,urine culture results of recipients with urinary tract infection and drug resistance characteristics of common pathogens during different stages after kidney transplantation were analyzed.The strains of patients with recurrent urinary tract infection were identified.The risk factors of urinary tract infection and the effect of urinary tract infection on renal allograft function were analyzed.Results The urinary tract infection rate was 90.0％in the first stage,49.3％in the second stage and 22.5％in the third stage.The urinary tract infection rates of male recipients undergoing living-related organ donation in the second and third stages were lower than those of female recipients(both P＜0.05).Urine culture test yielded positive results in 60 cases,and 84 strains of pathogenic bacteria were detected,mainly Gram-negative bacteria,among which Klebsiella pneumoniae accounted for the highest proportion.Sixty-six recipients had recurrent urinary tract infection,and the detected pathogens included Klebsiella pneumoniae,Escherichia coli and Candida glabrata,etc.Univariate analysis showed that postoperative use of antithymocyte globulin was the risk factor for urinary tract infection in the first stage.Preoperative urinary tract infection and donor type were the risk factors for urinary tract infection in the second stage.Gender and age of the recipients were the risk factors for urinary tract infection in the third stage.Multivariate analysis revealed that postoperative use of antithymocyte globulin was the risk factor for urinary tract infection in the first stage.Gender and age of the recipients were the risk factors for urinary tract infection in the third stage(all P＜0.05).In the third stage,65 cases were cured and 38 cases were not cured.In the treated recipients,the serum creatinine level and white blood cell count were decreased after corresponding treatment than those before treatment(both P＜0.05).Conclusions Gram-negative bacteria are the main pathogens of urinary tract infection in kidney transplant recipients,and drug resistance is relatively high.Postoperative use of antithymocyte globulin,female and old age are the risk factors for urinary tract infection in kidney transplant recipients.

Objective To explore the feasibility and safety of robot-assisted partial right nephrectomy using a combined retroperitoneal and transperitoneal approach in the treatment of horseshoe kidney with renal tumor.Methods Clinical and follow-up data of a patient with horseshoe kidney with renal tumor were retrospectively analyzed.Before operation,the diagnosis was confirmed with renal CT scanning and enhancement with angiography to show the blood supply.After that,the patient underwent robot-assisted partial right nephrectomy for horseshoe kidney by robot-assisted partial right nephrectomy using a combined retroperitoneal and transperitoneal approach.After operation,the patient was followed up.Results The operation went smooth with an operation time of 270 min.The intraoperative warm ischemia time was 30 min,intraoperative bleeding was approximately 300 mL,and no intraoperative or postoperative complications occurred.After 2 months of follow-up,the patient recovered well,and no chest and abdominal lymph node enlargement and lung metastasis were observed.Conclusion Robot-assisted partial nephrectomy of horseshoe kidney using a combined retroperitoneal and transperitoneal approach is a safe and feasible minimally invasive treatment option.

N?ive CD4+T cells play a key role in the initiation and maintenance of immune response.In the effect of cytokines and costimulatory molecules,they differentiate into Th1,Th2,Treg and Th17.Increasing evidences indicated that Th17 and Treg cells produce a significant effect on immune stability,autoimmune disease and cancer.Chronic prostatitis/chronic pelvic pain syndrome(CP/CPPS)is the most common type of prostatitis,accounting for 90%～95%,which is closely correlated with the progression of be-nign prostatic hyperplasia and prostate cancer.Benign and malignant diseases of the prostate share much similarity in immune microen-vironment.Thus,this review summarizs the latest research progress on the mechanism of Th17/Treg cells in prostatic disease.

【Objective】 To reduce the incidence of postoperative intestinal obstruction, we tried to improve surgical techniques by closing the cavity formed during radical cystectomy + ileal passage (Bricker) via laparoscopy to prevent the formation of abdominal hernia. 【Methods】 During Oct.2018 and Feb.2022, 41 patients were involved (conventional group). After standard laparoscopic radical cystectomy + pelvic lymphadenectomy, the ileum channel was established. The right medial retroperitoneum was sutured to cover the mesothelium and end of the ileum channel under open operation or endoscope. The space between the ureter and mesothelium of the ileum channel was sealed, and the end of the ileum channel and both ureters were externalized. During Feb.2022 and Dec.2022, 15 patients were involved (modified group). The right inner and outer lateral peritoneums below the ileal conduit were sutured to "bottom out" the gap between the ileal conduit and the right abdominal wall in addition to standard procedures. The recovery of intestinal function and incidence of bowel obstruction were compared between the two groups. 【Results】 In the conventional group, the intestinal function recovered within 2 to 6 days after surgery, with a median ventilation time of 3 days. Intestinal obstruction occurred in 3 patients, 2 of whom improved after conservative treatment while 1 underwent surgical exploration after ineffective conservative therapy. There were no significant differences in the time of discharge and ventilation between the two groups, but no intestinal obstruction occurred in the modified group. 【Conclusion】 Peritoneal externalization at the end of ileal passage can reduce the incidence of intra-abdominal hernia and postoperative intestinal obstruction, which is worthy of clinical application.

【Objective】 To evaluate the efficacy and safety of 450 nm semiconductor blue laser combined with triamcinolone acetonide injection in the treatment of bladder neck contracture (BNC). 【Methods】 A 61-year-old male patient with BNC and urethral stricture was treated with 450 nm semiconductor blue laser vaporization combined with triamcinolone acetonide injection. The surgery was performed with a small-caliber laser resectoscope of F22. The follow-up results 3 months after surgery were reported. 【Results】 The operation was successful, the operation time was 30 minutes, and the patient was discharged the next day after operation. Follow-up 3 months after operation showed the maximum urinary flow rate (Qmax) was 22.1 mL/s, the International Prostate Symptom Score (IPSS) was 2, the Quality of Life Scale (QoL) was 0, and no recurrence was observed. 【Conclusion】 It is safe and feasible to use 450 nm semiconductor blue laser combined with triamcinolone acetonide injection to treat bladder neck contracture through a small-caliber laser resectoscope of F22, especially for patients with urethral stricture. The short-term efficacy is satisfactory.

Laparoscopic renal pedicle lymphatic disconnection is the most effective method for treating chyluria that has failed to respond to conservative management. Chylous hemothorax is a rare clinical occurrence resulting from the anatomic abnormality. This paper reported a case, who was admitted with painless gross hematuria for 1 month and was diagnosed with left chylous hematuria. Laparoscopic left renal pedicle lymphatic disconnection was performed, and bilateral chylous hemothorax occurred after the operation. After conservative treatment such as bilateral closed thoracic drainage and blood transfusion support, the patient recovered well. After 2 months of follow-up, there was no obvious effusion in the bilateral thoracic cavity, and the chylous test of urine fluid was negative.

OBJECTIVES: To evaluate the feasibility and safety of bipolar-plasmakinetic transurethral enucleation and resection of the prostate (B-TUERP) in day surgery. METHODS: From January 2021 to August 2022, 34 patients with benign prostatic hyperplasia (BPH) underwent B-TUERP in day surgery in the First Affiliated Hospital of Anhui Medical University. Patients completed the screening and anesthesia evaluation before admission and received the standard surgery which implements "anatomical enucleation of the prostate" and "absolute bleeding control" on the same day of admission, and by the same doctor. Bladder irrigation was stopped, catheter was removed and the discharge evaluation was performed on the first day after operation. The baseline data, perioperative conditions, time of recovery, treatment outcomes, hospitalization costs, and postoperative complications were analyzed. RESULTS: All operations were successfully conducted. The average age of the patients was (62.2±7.8) years, average prostate volume was (50.2±29.3) mL. The average operation time was (36.5±19.1) min, the average hemoglobin and blood sodium were decreased by (16.2±7.1) g/L and (2.2±2.0) mmol/L, respectively. The average postoperative length of hospital stay, and total length of hospital stay were (17.7±2.2) and (20.8±2.1) h, respectively, and the average hospitalization cost was (13 558±2320) CNY. All patients were discharged on the day after surgery except for one patient who was transferred to a general ward. Three patients received indwelling catheterization after catheter removal. The 3-month follow-up results showed a substantial improvement in the International Prostate Symptom Score, quality of life score and maximum urinary flow rate (all P<0.01). Three patients experienced temporary urinary incontinence, 1 patient experienced urinary tract infection, 4 patients were diagnosed with urethral stricture and 2 patients experienced bladder neck contracture. No complications above Clavien grade Ⅱ occurred. CONCLUSIONS The preliminary results showed that B-TUERP ambulatory surgery is a safe, feasible, economical and effective treatment for appropriately selected patients with BPH.
Male ; Humans ; Middle Aged ; Aged ; Prostate/surgery* ; Prostatic Hyperplasia/surgery* ; Ambulatory Surgical Procedures ; Quality of Life ; Feasibility Studies ; Retrospective Studies ; Treatment Outcome

Abstract Chronic prostatitis is one of the common diseases in male urology．The disease of type Ⅲ prostatitis (chronic prostatitis / chronic pelvic pain syndrome) in the classification of prostatitis in the National Institutes of Health (NIH) cannot reflect the nature of the disease，such as unclear etiology and pathogenesis，diverse clinical manifestations，insufficient diagnostic basis，etc．The concept of type Ⅲ prostatitis does not regard the pelvic floor and lower urinary tract as a functional whole．Therefore，the China Chronic Prostatitis Diagnostic Criteria and Effi- cacy Evaluation Collaborative Group proposed to change the name of type Ⅲ prostatitis to prostatic pelvic syndrome and explore the establishment of symptom-based diagnostic and efficacy evaluation criteria to reflect the nature of the disease and meet the treatment objectives of type Ⅲ prostatitis patients to improve symptoms and improve quality of life．The proposal of new theories and the development of multi-center clinical trials will help urologists deepen their understanding of the prostatic pelvic syndrome and help them to correctly diagnose and treat the syndrome.

Objective:To analyzed the urinary microbiota characteristics of upper tract urothelial carcinoma(UTUC) patients.Methods:Urine samples were collected from 23 patients with UTUC (UTUC group) and 22 patients with benign diseases (control group) admitted to Yijishan Hospital, the First Affiliated Hospital of Wannan Medical College from July 2021 to July 2022. The differences in age [(60.9±5.7) years vs. (61.4±8.8) years], sex (male/female: 15/8 vs. 9/13), and body mass index [(22.9±1.8) kg/m 2 vs. (23.4±1.7) kg/m 2] between the UTUC group and the control group were not statistically significant ( P>0.05). The V4 region of the 16S rRNA of urinary microorganisms was sequenced using the Illumina NovaSeq6000, and the results were processed using QLLME2. Differences in α-diversity between groups were analyzed by using the Shannon, Simpson, and Chao1 indices. Differences in β-diversity between groups were analyzed by using unweighted principal coordinates analysis (PCoA). Linear discriminant analysis Effect Size(LEfSe)was used to identify the bacterial taxa with different abundances between groups. Significant differences were defined as LDA>2. Results:The Chao1 index (703.12±265.54 vs. 506.20±214.02) and Shannon index (5.61±1.85 vs. 5.07±1.34) were significantly higher in the UTUC group compared to that in the control group ( P<0.05). The α-diversity of urinary microbes was elevated in the UTUC group compared to that in the control group but the difference in β-diversity was not statistically significant ( P=0.161). The enrichment of Bacteroidaceae, Ruminococcaceae, Acidaminococcaceae, Thermaceae, Erysipelatoclostridiaceae, and Coriobacteriaceae abundance was higher in the urine of UTUC patients(LDA > 2). Further subgrouping analyses of the UTUC patients showed that the differences in Chao1 index (706.44±271.84 vs. 784.09±272.72), Shannon index (6.04±1.30 vs. 5.91±1.67), and Simpson index (0.94±0.08 vs. 0.89±0.22) between the muscle-invasive group and the non-muscle-invasive group were not statistically significant ( P>0.05). The difference in α-diversity between muscle-invasive and non-muscle-invasive group was not statistically significant, but the difference in β-diversity was statistically significant ( P=0.047). The urinary microbial communities of Gammaproteobacteria, Cutibacterium, Rhodococcus and Nocardiaceae were enriched in muscle-invasive group and differed from that in non-muscle-invasive group(LDA>2). Conclusions:This study suggests that the urinary microbial community was more abundant in UTUC patients than in non-UTUC patients and that Bacteroidaceae, Ruminococcaceae, Acidaminococcaceae, Thermaceae, Erysipelatoclostridiaceae, and Coriobacteriaceae were more abundant in the urine of UTUC patients. The urinary microbial community was more abundant in the urine of non-muscle-invasive patients than in the muscle-invasive patients, and Gammaproteobacteria, Cutibacterium, Rhodococcus and Nocardiaceae were more abundant in the urine of non-muscle-invasive patients.