Objective:To investigate the efficacy and safety of modified early unclamping technique in robot-assisted laparoscopic partial nephrectomy (RAPN) for patients with renal tumors.Methods:A total of 32 renal tumor patients undergoing RAPN with modified early unclamping technique between January 2019 and August 2020 were retrospectively collected, including 18 males and 14 females. The average age was (48.5±11.2) years old, average BMI was (23.8±3.7) kg/m 2, average tumor size was (4.2±1.4)cm with 18 left tumors and 14 right tumors, average R. E.N.A.L. score was 7.6±0.4, and average preoperative eGFR was (84.0±18.6)ml/(min·1.73 m 2). The control group included 66 renal tumor patients undergoing RAPN with standard unclamping technique during the same period by the same surgeon, including 42 males and 24 females. The average age was (50.2±13.8) years old, average BMI was (24.0±4.5)kg/m 2, average tumor size was (4.1±1.6)cm with 35 left tumors and 31 right tumors, average R. E.N.A.L. score was 7.5±0.5, and average preoperative eGFR was (82.8±20.2) ml/(min·1.73 m 2). There was no significant difference in above variables between two groups. Modified early unclamping technique used barbed wire to continually suture 2-3 needles in a short time to close the large space at the outer after the inner suture, and then loosen the blocking clip to restore renal blood supply. The operative time, warm ischemia time, blood loss, postoperative tube removal time, postoperative hospital stay and 3 months postoperative renal function of two groups were compared. Results:All of the 98 RAPN were performed successfully and no patient was converted to radical nephrectomy or open surgery. There was no significant difference in operation time [(120.9±22.8)vs.(111.6±25.0)min, P=0.079], postoperative tube removal time [(4.0±0.6)day vs.(3.8±0.8) day, P=0.214] and postoperative hospital stay [(5.1±0.7)day vs.(5.2±0.5) day, P=0.419] between the two groups. Compared with the standard unclamping group, the modified early unclamping group had obvious less warm ischemia time [(13.5±3.6)min vs.(21.2±4.4) min, P<0.001]. There was no difference in intraoperative estimated blood loss between two groups (110 ml vs. 100 ml, P=0.480). No blood transfusion, urine leakage, postoperative hemorrhage occurred in either group. The 3 months postoperative renal function decline of modified early unclamping group was slightly less than standard unclamping group [(10.5±7.6)ml/(min·1.73m 2)vs.(13.2±6.4) ml/(min·1.73m 2)], but did not reach statistical significance ( P=0.069). The median follow-up period was 12.4 months(4-24 months) without any recurrence or metastasis. Conclusions:The modified early unclamping technique in RAPN for patients with renal tumors is safe and feasible. Compared with the standard unclamping technique, the modified early unclamping technique could shorten the warm ischemia time without increasing blood loss and complications, and might protect the postoperative renal function, which has high value in clinical practice.

Objective:To compare the clinical efficacy and cost of robot-assisted laparoscopic adrenalectomy with da Vinci Xi and Si surgical system in the treatment of adrenal tumors.Methods:The clinical data of 99 patients performing robotic-assisted laparoscopic adrenalectomy in our hospital between June 2019 and December 2020 were retrospective analyzed. Among them, 57 cases were Si system robot assisted laparoscopic adrenalectomy (group Si), 35 male, 22 female; age (45.6±14.0)years; BMI(21.0±1.2); 6 with diabetes, 10 hypertension, 14 with abdominal surgery; 28 left, 29 right; 9 ASA score ≥3; tumor diameter (3.9±1.2)cm. There were 42 cases of Xi system robot-assisted laparoscopic adrenalectomy (group Xi), 21 male, 21 female; age(44.8±14.5)years; BMI(21.4±1.8); 2 with diabetes, 12 hypertension, 11 with abdominal surgery; 15 left, 27 right; 7 with ASA score ≥3; tumor diameter (3.7±1.1) cm. Sex, age, BMI, comorbidities, history of abdominal surgery, lateral division, ASA score, and tumor diameter were not significantly different between the two groups ( P>0.05). Operation method: except for the different docking procedures, the same surgical procedures were roughly performed in the two groups. The docking method of the Si group was the doctor holding the attractor as the guide. The operating room nurse introduced the robot cart under the guidance of the attractor, and then completed the docking.Group Xi docking adoptd the own laser positioning system of the robot system, without manual positioning and guidance; the mechanical arm of the Xi system was also more flexible. Complications were graded according to the Clavien-Dindo grading system. Comparing the treatment effect, safety, and cost of the two groups were compared. Results:The anesthesia times in the Si and Xi groups were (140.0±24.3) min and (125.6±26.4) min ( P=0.006), respectively. The surgical times in the Si and Xi groups were (109.0±18.8) min and (98.8±20.7) min (P=0.013), respectively. The docking times between the Si and Xi groups were (7.8±1.4) min and (5.0±0.9) min ( P<0.001), respectively. The estimated intraoperative blood loss in the Si and Xi groups was (121.5±70.8) ml and (124.7±68.9) ml ( P=0.824), respectively. The postoperative indwelling times of the drainage tube in the Si and Xi groups were (3.4±1.2) d and (3.4±1.3) d ( P=0.892), respectively. Postoperative bed times in the Si and Xi groups were (2.3±1.0) d and (2.5±1.2) d ( P=0.419), respectively. Postoperative hospitalization times in the Si and Xi groups were (6.4±1.5) d and (6.2±1.5) d ( P=0.484), respectively. Post Clavien ≥ grade 3 complications were four and two in groups Si and Xi, respectively ( P=0.642). The total cost during hospitalization in the Si and Xi groups was (51 975.2±7 320.8) Yuan and (56 830.9±8 392.5) Yuan, respectively ( P=0.003). The surgery and consumables costs for the Si and Xi groups were (23 785.3±4 063.1) Yuan and (28 021.2±6 066.8) Yuan ( P<0.001), respectively. Conclusions:Compared with the Si system, the Xi system robot-assisted laparoscopic adrenalectomy can provide similar perioperative results and safety, and shorten the time of anesthesia and surgery, but the total cost of hospitalization is increased.

Objective:To compare the efficacy and safety of robot-assisted laparoscopic and laparoscopic partial nephrectomy (RAPN and LPN) for patients with completely endophytic renal tumor.Methods:A total of 73 patients with completely endophytic renal tumor receiving RAPN (n=29) or LPN (n=44) in our center between January 2015 and June 2021 were retrospectively collected. There were 21 males and 8 females in RAPN group. The average age was 48.6±13.7 years old, average tumor size was 2.9±0.9 cm with 13 left tumors and 16 right tumors, average R. E.N.A.L. score was 9.2±1.0, and average preoperative eGFR was 82.6±10.7 ml/(min·1.73 m 2). There were 27 males and 17 females in LPN group. The average age was 50.1±12.3 years old, average tumor size was 2.9±0.9 cm with 24 left tumors and 20 right tumors, average R. E.N.A.L. score was 9.1±1.3, and average preoperative eGFR was 81.7±9.6 ml/(min·1.73 m 2). There was no significant difference in above variables between two groups. The operative time, warm ischemia time, blood loss, postoperative complication, postoperative hospital stay and postoperative 3 months renal function of two groups were compared. Results:All 73 patients successfully underwent RAPN or LPN and no patient converted to radical nephrectomy or open surgery. There was no significant difference in operation time [140(80, 160) min vs. 150 (90, 180) min, P=0.264], intraoperative estimated blood loss[150 (100, 200)vs. 180 (120, 200) ml, P=0.576]and postoperative hospital stay (7.0±2.7 vs. 7.4±2.1 days, P=0.480) between two groups. Compared with LPN group, RAPN group had obvious less warm ischemia time (23.1±3.3 vs. 27.6±4.7 min, P<0.001). No obvious complication occurred in RAPN group and one case with postoperative hemorrhage occurred in LPN group. No positive margin occurred in either group. There was no difference in renal function 3 months after operation between the two groups [73.2±6.3 vs.70.5±7.6ml/(min·1.73 m 2), P=0.117]. The median follow-up period was 22.6 months with no tumor recurrence or metastasis. Conclusions:For experienced surgeons, both RAPN and LPN are safe and feasible for patients with completely endophytic renal tumor. Compared with LPN, RAPN has advantages of perioperative curative effect, which could reduce the operating difficulty and shorten the warm ischemia time.

Objective To introduce the technique and report our initial experience of transvesical robot assisted radical prostatectomy (TvRARP).Methods From April 2018 to August 2018,10 patients underwent TvRARP performed by a single surgical team were retrospectively reviewed.Preoperative data of patients [aged (58.6 ± 9.4) years,BMI (26.5 ± 3.1) kg/m2,tPSA (19.5 ± 4.1) ng/ml,biopsy Gleason score 6(6-7),prostate volume (33.4 ± 15.8) ml and IIEF-5 score 12 (10-16)] were collected.Preoperative study revealed 8 cases of cT1c,1 case of cT2a and 1 case of cT2b.All patients were continent preoperatively.During the surgical procedure,the bladder was opened,and a circumferential incision was then made around the internal urethral orifice.Initially,posterior dissection of bilateral vas deferens and seminal vesicles was performed,followed by posterior dissection towards apex.Lateral dissection of neurovascular bundles was performed before anterior dissection towards apex.The exposed urethra was transected and specimen was removed.Vesicourethral anastomosis and closure of bladder was performed in a standard way.Results All 10 cases were successfully performed robotically without conversion,transfusion or other major intraoperative or postoperative complications.Postoperative pathology confirmed 6 cases of pT2a,3 cases of pT2b and 1 case of pT2c [median Gleason score 6 (6-7)].One case was reported positive surgical margin.Operative time was (140.5 ± 35.5) mins.Estimated blood loss was (65.5 ± 35.5) ml.Urethral catheter was removed at 7 days postoperatively.Nine patients achieved urinary continence (0 pads) immediately after the removal of urinary catheter,while 1 patient returned to full continence at 2 weeks postoperatively.During a mean follow-up of 3 months (2-4 months),no biochemical recurrence was detected (tPSA ＜ 0.2 ng/ml).At 2 months postoperatively,IIEF-5 score was 11 (8-13) and no statistically difference was made compared with preoperative data (p ＞ 0.05).Conclusions Transvesical approach is a valid alternative of RARP in patients bearing localized low-risk prostate cancer.Tumor control and preservation of erectile function remains to be determined by long term follow-up.

Objective To introduce the technique and report our initial experience of Retziussparing robotic-assisted laparoscopic radical prostatectomy (RALP) and compare perioperative outcomes with the standard veil of Aphrodite technique (Veil technique).Methods nineteen Retzius-sparing RALP and 20 Veil nerve sparing RALP with posterior reconstruction for T1c to T2c prostate cancer performed by a single surgical team between 2015 January and 2016 December were retrospectively reviewed.Preoperative data of patients in Retzius-sparing group [patient age (66.3 ± 5.9) years,BMI (25.5 ± 3.1) kg/m2,tPSA (16.4 ± 5.0) ng/ml,biopsy Gleason score 6 (5-7),prostate volume (32.7 ± 7.4) ml and IIEF-5 score 14(5-18)] and Veil group[patient age (64.6 ±7.3) years,BMI (25.5 ±2.0) kg/m2,tPSA (18.5 ± 11.0) ng/ml,biopsy Gleason score 7(5-8),prostate volume (31.4± 10.8)ml and IIEF-5 score 15(6-19)].No significant difference was found between the two group in the above parameters (all P ＞ 0.05).All patients were continent preoperatively.Retzius-sparing RALP and Veil nerve sparing RALP were performed via transperitoneal RALP.Operative time,estimated blood loss,postoperative hospital stay,postoperative staging,postoperative Gleason score,return of urinary continence and postoperative IIEF-5 score of the two groups were statistically analyzed.Results All 39 cases were successfully performed robotically without conversion,transfusion or other major intraoperative and postoperative complications.Postoperative pathology confirmed pT2a 5 cases,pT2b 8 cases and pT2c 6 cases in Retzius-sparing group and pT2a 7 cases,pT2b 5 cases and pT2c 8 cases in Veil group (all P ＞ 0.05).For Retzius group,operative time was (106.5 ± 26.4) min and estimated blood loss was (48.9 ± 20.2) ml;for Veil group,operative time was (93.2± 20.8) min and estimated blood loss was (42.5 ± 16.8) ml.No significant difference was found in the above parameters (all P ＞ 0.05).Urethral catheter was removed at postoperative 7-day (Retzius-sparing group) and 21-day (Veil group),respectively.18 patients in Retzius-sparing group achieved urinary continence (0 pads) immediately after the removal of urinary catheter,while 1 patient returned to full continence in 2 weeks postoperatively.Patients in Veil group returned to continence (6.8 ± 3.6) weeks postoperatively (P ＜ 0.001).At 3-month follow up,IIEF-5 score was 14 (4-16) in Retziussparing group and 14 (4-18) in Veil group;no significant changes was noted in preoperative and postoperative IIEF-5 score in both groups,or in postoperative IIEF-5 scores in the two groups (P ＞ 0.05).No sign of tumor recurrence was appreciated for all cases (tPSA ＜ 0.2 ng/ml) during follow-up of 6 months (3 to 12 months).Conclusions Retzius-sparing RALP and the Veil nerve sparing RALP were both effective for the surgical treatment of localized prostate cancer.Our data revealed no statistical difference in perioperative outcomes between the two approaches,however,the Retzius-sparing technique seemed to yield a better outcome regarding early return to urinary continence postoperatively.

Background and purpose:Bladder cancer is the most common urological tumor, and its pathogen-esis is still not fully understood. The study was aimed to observe the expressions of key genes in many tumor-associated signaling pathways in normal bladder tissue and bladder carcinoma, and to provide further evidence for the subsequent study of bladder cancer recurrence and metastasis.Methods:Twenty-seven cases of bladder cancer specimens were col-lected, and normal bladder tissues and bladder cancer tissues were distinguished by frozen section. Then, the expressions of 84 genes of cancer-related signaling pathways in bladder cancer tissues and normal bladder tissues were screened by Cancer Pathway Finder PCR Array produced by QIAGEN company.Results:Compared with the normal bladder tissues, the bladder carcinoma tissues had 8 up-regulated genes and 19 down-regulated genes. In this study, the impact of epithe-lial-mesenchymal transition (EMT) signaling pathway was selected as a research direction in which theGSC,KRT14,DSP were up-regulated,SNAI2,SNAI3 were down-regulated. ThereforeGSC,KRT14,DSP,SNAI2 andSNAI3 were chosen as target genes, and verified by qRT-PCR in many examples. The result showed that the expressions ofGSC gene in bladder cancer tissues were up-regulated, but with no statistical significance;KRT14,DSP expressions in bladder cancer were higher than those in normal bladder tissues (P<0.05);SNAI2,SNAI3 expressions in bladder cancer were lower than those in normal bladder tissues (P<0.05), andSNAI3 showed the most obvious expression differences.Conclusion:KRT14,DSP andSNAI3 may play an important role in bladder cancer’s occurrence, development and metastasis.

Objective To investigate the effect of notch signaling pathway on drug resistance and invasiveness of bladder cancer .Methods We observed the changes of growth and morphology of bladder cancer T 24 , 5637 and J82 cells which treated for 48 hours using γ-secretase inhibitor by inverted microscope .The mRNA and protein lev-els of the EMT molecular markers , including E-cadherin , N-cadherin , vimentin and Alpha-smooth muscle actin were examined by RT-PCR and Western blot in bladder cancer cells;Detected the changes of drug resistance and invasion respectively by MTT and Transwell in bladder cancer cells .Results After completely blocking the Notch signaling pathway , the inverted microscope showed that bladder cancer cells became smaller and more disperse ;RT-PCR and Western blot showed the mRNA and protein levels of E-cadherin were up-regulated ( P<0.05 ) , contrast , N-cadherin , vimentin and Alpha-smooth muscle actin were down-regulated ( P<0.05 ); The prolifera-tion of bladder cancer cells were significantly inhibited by MTT test;The number of through microporous membrane cells significantly decreased ( P<0.05 ) shown by Transwell test .Conclusions The Notch signaling pathway is completely blocked that nhibites proliferation and EMT of bladder cancer cells , reduces drug resistance and inva-sion in bladder cancer cells .It suggests that drug resistance and invasiveness of bladder cancer can be changed through EMT which is regulated through notch signaling pathway .

Objective To investigate the efficacy and safety of high-intensity focused ultrasound (HIFU) in treatment of chyluria.Methods Retrospectively analyze the HIFU-based treatment results of 131 patients with chyluria received treatment between Jan 2010 and Jun 2011.The patients' age ranges from 23 to 83 years old,with average 59.The patients consisted of 59 male patients and 72 female patients.74 cases were on the left side,right side 51 cases,6 cases bilateral.There were 47 patients with chylous hematuria,22 cases of recurrence after renal pedicle lymphatic vessel ligation,5 cases of recurrence after laparoscopic ligation of renal lymphatic,1 cases of recurrent pelvic perfusion after silver nitrate.The treatment was carried out according to the following procedure.The affected kidney pedicle and superior segment of ureter,after being divided into two or three irradiation layers,were irradiated daily from deep to superficial layers which completely cover the affected kidney pedicle and superior segment of ureter.The technical parameters of the treatment were:focal region size 4 mm×4 mm×7 mm,Ultrasonic power 800-1100 W,Unit firing time 0.15s,Dutv time 0.18s,Single point total transmit 50 times.The patients were followed up and re-examined within one to five years after treatment.Statistical analyses were conducted on the data of Color doppler ultrasound images on kidney pedicle and renal function tests before and after the treatment,blood routine examination and routine urianlysis.Results 116 patients were followed up and the treatment to 96 of them was deemed effective in which 85 patients completely recovered (73.3％ recovering rate) and 11 patients became better (9.5％).The other 20 patients (17.2％) was ineffective.With regard to the time required to cure chyluria,67 patients (69.8％) required one week,13 (13.5％) required two weeks,11 (11.5％) required four weeks,and 5 (7.5％) required five weeks.Results of color doppler ultrasound images on kidney pedicle and renal function tests were as follows.The volume of kidney,the inner diameter of renal artery,Vmax,RI,inner diameter and blood flow rate of renal vein and serum Cr,serum BUN had no significant difference before and after the treatment (P＞0.05).Results of anemia,hematuria,microscopic hematuria and urinary protein positive were significantly different from the before-treatment results (P＜0.05).During the treatment process,all patients had stable vital signs without serious complications.Conclusions Treating chyluria with HIFU could be a safe and effective method.

Objective To evaluate periphery artery and renal injury in elderly patients with dipper and non-dipper isolated systolic hypertension(ISH). Methods Totally 187 elderly cases were divided into 51 patients with non-dipper hypertension,70 patients with dipper hypertension aged (72.4±5.6) years and 66 cases with normal blood pressure as control according to results of dynamic blood pressure recorder. Ankle-brachial index (ABI),brachial ankle artery pulse wave velocity (baPWV),retinol-binding protein (RBP) and Cystatin C were assessed. ABI and baPWV were determined by a non-invasive automatic waveform analyzer. Results The baPWV value in nondipper group was higher than dipper group [(1869.3±285.6)cm/s vs.(1703.1±235.2)cm/s,q=4.73,P＜0.01],while the value of ABI in non-dipper group was lower than dipper group (1.0 ±0.2vs.1.1±0.2,q=4.74,P＜0.01).The level of Cystatin C was elevated in non-dipper group versus dipper group [(1.4±0.5) mg/L vs. (1.0±0.5)mg/L,q=6.92,P＜0.01]. There were no differences in RBP concentration among the three groups (F=2.39,P＞0.05).At baPWV＞ 1400cm/s,the level of Cystatin C was increased in 47 cases with non-dipper hypertension as compared with 64 cases with dipper hypertension [(1.4±0.5)mg/L vs.(1.1±0.5)mg/L,q=5.59,P＜0.01].Conclusions The elderly patients with non-dipper hypertension may be more easily suffered from periphery artery and renal injury in comparison with dipper hypertension.

Objective To investigate the effect of human interferon-beta (IFN-β) gene engineered human mesenchymal stem cells (hMSC) in the treatment of human prostate cancer xenograft in nude mice.Methods An adenovirus vector containing human IFN-β gene was constructed and transfected into hMSC in vitro.IFN-β-expressing mesenchymal stem cells (IFN-β-hMSC) were labeled with 4,6-diamidino-2-phenylindole (DAPI).The human prostate cancer cell line PC-3 were injected into the flank or axillary of severe combined immunodeficiency (SCID) mice subcutaneously to establish human prostate cancer xenograft models.IFN-β-hMSC were injected into the tail vein of mice bearing human prostate cancer xenografts.The tumors,livers,lungs,spleens and kidneys were harvested.Frozen sections and paraffin sections were used to observe the distribution of IFN-β-hMSC in vivo by fluorescence microscope.Mice were divided into seven groups of six animals randomly,IFN-β-hMSC (2 × 106,2 × 105 ) as treatment group,Ad-hMSC,unmodified hMSC,Ad-IFN-β,Recombinant IFN-β,and NS as control group.The weight of the tumor and the survival time of mice were observed to evaluate the experimental efficacies of IFN-β-hMSC in the treatment of prostate cancer. Results IFN-β-hMSC with blue nuclei were distributed extensively in the tumors,but no blue nucleus was seen in the livers,lungs,spleens and kidneys.After treating,the weights of the tumour masses from mice were (1.35 ±0.28) g,(1.43±0.41) g,(3.49 ±0.25)g,(3.58±0.30)g,(3.30 ±0.24) g,(3.32 ±0.25) g,(3.32 ±0.47) g in the IFN-β-hMSC (2 ×106),IFN-β-hMSC (2 ×105),Ad-hMSC,unmodified hMSC,Ad-IFN-β,Recombinant IFN-β,and NS group,the median survival time from mice were 91 d,87 d,57 d,59 d,62 d,61 d,61 d in the IFN-β-hMSC (2 × 106),IFN-β-hMSC (2 × 105),Ad-hMSC,unmodified hMSCs,Ad-IFN-β,Recombinant IFN-β,and NS group,respectively.Injection of IFN-β-MSC can significantly reduce tumor weight and increase animal survival compared with controls ( P ＜ 0.05 ). Conclusion IFN-β-hMSC can migrate to prostate cancer microenviroment in vivo,and injection of IFN-β-MSC can significantly reduce tumor weight and increase animal survival.