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 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 clinical characteristics of urodynamics in elderly male patients with indwelling urinary catheterization. Methods: Clinical urodynamics of 497 male patients with indwelling urinary catheterization aged 60 years and over from December 2010 to April 2019 in our center were retrospectively analyzed and divided into 3 groups: 60-69-year-old group(n=114), 70-79-year-old group(n=220), and 80-111-year-old group(n=163). According to the catheter indwelling time, the patients were divided into 3 groups: 1-2 weeks group(n=262), 2-4 weeks group(n=47)and over 4 weeks group(n=188). The cause of indwelling urinary catheterization, bladder outlet obstruction, acontractile detrusor and other indicators were observed. Results: The main cause of indwelling urinary catheterization in elderly men was acute urinary retention(55.1%, 274 cases), in that the most common diagnosis was benign prostatic hyperplasia(90.3%, 449 cases). No statistically significant difference in the different catheter indwelling time-related urodynamics between the different age groups was found(χ²=1.606, 0.199 and 2.477, all P>0.05). There were statistically significant differences both in the incidences of bladder outlet obstruction between the 1-2 weeks vs.2-4 weeks vs.over 4 weeks groups[56.9%(149/262)vs.55.3%(26/47) vs.42.6%(80/188), χ²=9.315, P<0.05)], and in the incidences of acontractile detrusor between the 1-2 weeks vs.2-4 weeks vs.over 4 weeks groups[15.6%(41/262)vs.12.8%(6/47)vs.29.8%(56/188), χ²=15.319, all P<0.05)]. There was no statistically significant difference in catheter indwelling time-related urodynamics between two groups with normal detrusor muscle function and weak detrusor muscle function(P>0.05). Clinical urodynamics had no statistically significant in different age groups(P>0.05). Conclusions Bladder outlet obstruction is the main cause of indwelling urinary catheterization in elderly men.Urodynamic examination can be performed 1-2 weeks after indwelling urinary catheterization.Age has no significant effect on the catheter indwelling time-related urodynamics.The duration of indwelling urinary catheterization has little effect on the urodynamic diagnosis in patients with normal or weak detrusor muscle contractile strength.The elderly patients may have acontractile detrusor if the duration of indwelling urinary catheterization is more than 4 weeks.

膀胱癌是泌尿系统器官中最常见的恶性肿瘤之一，其病因及发病机制尚不十分清楚，且其具有发病率高、恶性程度高 以及术后易复发等特点，因此对其病因、发生发展的具体分子机制的研究及阐明，将有力地促进膀胱癌的诊断及治疗。长链非编 码RNA（long non-coding RNA，lncRNA）是细胞中一类转录本长度超过200个核苷酸的非编码RNA分子， 占RNA总量的98%。 lncRNA具有与mRNA相似的结构，经过转录后加工，也具有polyA尾巴和启动子结构，但是由于序列中缺少开放阅读框，而不参 与或很少参与蛋白质编码。近年来，随着二代测序技术的广泛应用，越来越多的研究发现lncRNA在多个层面上参与细胞分化和 个体发育等重要生命活动过程的调控，并与人类的重大疾病尤其是肿瘤密切相关。相关的研究表明，lncRNA参与靶基因的表达 调控，在肿瘤的发生发展中发挥着重要的作用。本文对lncRNA在膀胱癌方面的最新研究进展进行了文献综述。

Objective To investigate the safety and efficacy of same session ureteroscopical lithotripsy as a valuable treatment for the bilateral upper urinary stones.Methods 32 cases with bilateral upper urinary stones were enrolled into this study from Jan 2013 to Dec,including 19 male and 13 female.The age ranged from 19 to 79 years old [mean (53.2 ± 14.2) years old].Ultrasound,CT and IVU were used to evaluate the details about the stone burden,number and location.The total stone burden was (23.7± 7.6)mm,ranged from 14 to 40mm.The kidney stone burden ranged from 0 to 37mm [mean (15.4 ±9.7)mm].and ureter stone burden ranged from 0 to 34 mm [mean (8.2 ±7.2)mm].Total stone number was 109,including 78 stones in kidney and 31 stones in ureter.23 (71.9％) patients had stents placed before the surgery.All the patients were treated with FURL and(or) URL by the same surgeon under general anesthesia,and C arm was used routinely to monitor the position of the guide wire,sheath and residual stones.The stents were placed for 2 to 4 weeks post-operatively.The ureteral catheters were placed for 24 to 48 hours.Stone-free rates(SFRs) were judged by KUB and(or)NCCT on the first day after the surgery and one month after withdraw the stent.The number of procedures,operative duration,hospital stay,SFRs in different time phase,serum creatinine,stone composition and complications were evaluated.All patients were divided into low burden group and high burden group,based on the borderline of stone burden (20mm).The SFR and complication was compared among those group.Results Among 32 cases,30 cases underwent the one stage procedure and 2 cases underwent two stage procedure.Operative time was (99.2 ± 32.5) mins.There was no significant difference of serum creatinines before and after the surgery.[(78.3 ± 15.0) μmoL/L vs.(77.9 ± 15.3) μmol/L,P =0.711].The overall SFRs aftcr 1,2 procedures were 84.0％ (27/32) and 91.0％ (29/32),respectively.The immediate SFRs for patients with a preoperative stone burden ≤20 and ＞20 mm showed significant difference(100％ vs.50％,P =0.002).Only 5 minor postoperative complications,including fever in 4 patients,hematuria in 1 were recorded.Longterm complication,such as ureteral stricture,was not noticed.Conclusions For selected cases with bilateral upper urinary stones,bilateral same-session ureteroscopy is effective and safe with little influence on the kidney function.For those whose stone burden less than 20mm,the immediate SFRs are much higher.

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.

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 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 formulate paclitaxel loaded polymer nanoparticle and evaluate it's application in treatment of bladder.Methods Paclitaxel loaded Poly (lactide-co-glycolide) (PLGA) nanoparticles were formulated with microemulsion method,Polyvinyl alcohol(PVA) was used as surfactant.Transferrin (Tf) was used to modify the nanoparticles.The size,Z-potential,drug loading,drug release,cytotoxicity of bland nanoparticles and paclitaxel-loaded nanoparticles on bladder cancer cell line J-82 were measured.Results The size of nanoparticles was about 200 nm,Z-potential was-24 mV,drug loading was about 6.5％ (w/w),cumulative drug release showed two phase curve.The size of Tf modified nanoparticles was a little bigger than no modified nanoparticles.The Z-potential,drug loading,drug release was similar.Two kinds of blank nanoparticles showed no cytotoxicity on bladder cancer cell line J-82.However,both paclitaxel-loaded nanoparticles had significantly higher cytotoxicity on J-82 compared to paclitaxel solution.Conclusions PLGA nanoparticle is a promising drug delivery vehicle,which could significantly improve the anticancer effect of paclitaxel on bladder cancer.

Objective To verify the efficacy and safety of intravesical instillation of Cystistat in reducing complications caused by intravesical chemotherapy after TUR-BT in non-muscle invasive bladder cancer patients. Methods One hundred and twenty patients who met the inclusion/exclusion criteria were enrolled into this multi-centered, randomized and blank controlled clinical study. Selected patients were randomized into the observation group and control group. TUR-BT was carried out in both groups followed by pirarubicin (THP) and Cystistat intravesical instillation in the observation group, and THP intravesical instillation alone in control group. Visual analog scale (VAS) was used as the primary efficacy variable. The secondary efficacy variables were assessments of hematuria and bladder irritation symptoms. Adverse events, laboratory tests and changes of vital signs before and after treatment were strictly observed during observation to evaluate the efficacy and safety of Cystistat.Results Demographics and baseline characteristics were comparable in both groups. The differences and the improvement rate of VAS score in the 2 groups were significant, both P＜0.01. The changes of VAS score and the improvement rate before and after treatment were (2. 24±1.70) and (92. 92±14.76) % in observation group and (0. 70±1.82) and (20. 59±87.34)% in control group respectively. According to the covariance analysis, there were significant differences in changes of VAS score between the observation group and the control group. Also, the improvement rate of VAS score was significant from visit 2. The urine frequency decreased from 9.06±4.09 to 6. 69±2.89 in observation group and increased from 8. 85±3. 32 to 10. 15±4.40 in control group, P＜0.01. There were also significant differences in changes of nocturia before and after treatment between these two groups (P＜0.01), the nocturia decreased from 2. 88±1.74 to 1. 47±1.62 in observation group and 3. 22±2.30 to 2.91±1.73 in control group, respectively. The changes of WHO assessment for hematuria,urgency and dysuria were not significantly different between the 2 groups. No Cystistat related adverse event was observed. Conclusions Cystistat combined instillation can significantly improve the VAS score of patients with chemotherapeutic agent instillation. Relief of bladder pain, frequency and nocturia are more rapidly and more durable in Cystistat combined instillation group. The improvement is more effective in patients with a high VAS score. Cystistat instillation with chemotherapeutics agents is both well tolerated and safe.