Understanding intrarenal backflow: Intrarenal pressure during ureteroscopy and beyond

The number of ureterorenoscopic procedures for upper urinary tract stone management has increased dramatically during recent years worldwide[1].Developments in flexible ureteroscope and laser technology have made it possible to successfully address larger and more complex stone scenarios retrogradely.On the other hand,this means that more and more patients are exposed to the potential adverse effects of ureteroscopy[2].In general,ureteroscopy is considered a safe procedure.However,serious complications and even deaths do occur,and these events are most likely underreported[3,4].

The global,prevalence,and risk factors of postoperative fever after percutaneous nephrolithotomy:A systematic review and meta-analysis

Objective:This study aimed to explore the global,prevalence,and risk factors of fever after percutaneous nephrolithotomy(PCNL)by conducting a systematic review and meta-analysis.Methods:The high-sensitivity searching was conducted without time limitation until December 30,2020 in Web of Sciences,Scopus,and PubMed based on inclusion and exclusion criteria.Results:The prevalence rates of fever and sepsis among patient undergoing PCNL were estimated 9.5%(95%confidence interval[CI]:9.3%-9.7%),and 4.5%(95%CI:4.2%-4.8%),respectively.Nephrostomy tube was used in 9.96%(95%CI:9.94%-9.97%)of patients.The mean preoperative white blood cells of patients were 6.401×109/L;18.3%and 4.55%of patients were considered as the positive urinary culture and pyuria,respectively.About 20.4%of patients suffered from residual stones.The odds ratios(ORs)of fever in patients who suffering from diabetes mellitus,hydronephrosis,staghorn stones,and blood transfusion were 4.62(95%CI:2.95-7.26),1.04(95%CI:0.81-1.34),2.57(95%CI:0.93-7.11),and 2.65(95%CI:1.62-4.35),respectively.Patients who underwent PCNL in prone position were more likely to develop fever(OR:1.23;95%CI:0.75-2.00)than patients in supine position.Conclusion:The current study showed that patients who suffer from diabetes mellitus,hydronephrosis,staghorn stones,nephrostomy tube or double-J stent,blood transfusion,and also patients who underwent PCNL in prone position surgery are more likely to develop a postoperative fever after PCNL.

Outcomes of surgical correction of Peyronie’s disease with plaque excision and grafting: Comparison of testicular tunica vaginalis graft versus bovine pericardium graft

Objective:Peyronie’s disease(PD)is an abnormal wound healing in the penile tunica albuginea.After fibrotic plaque excision,different graft materials have been used to repair the defects,but the optimal graft remains unknown.This study aimed to compare the functional outcomes of testicular tunica vaginalis grafts and bovine pericardium grafts in patients with severe PD.Methods:A retrospective comparative study was conducted on 33 PD patients undergoing partial plaque excision and grafting from September 2015 to May 2021.The patients were divided into two groups depending on the type of graft used.For 15 patients in Group B,testicular tunica vaginalis grafts were used to repair the defect,while for 18 patients in Group A,bovine pericardium grafts were used.Data of the patient’s age,comorbidities,sexual function,penile curvature,postoperative complications,need for further treatment,change in penile length,and satisfaction were gathered and compared between the groups.Sexual function was evaluated using the 5-item version of the International Index of Erectile Function(IIEF-5),and a functional less than 20-degree penile curvature after surgery was considered a successful intervention.Results:There was no difference in age,comorbidities,degree of curvature,perioperative IIEF-5,operative time,plaque size,or complication rates.After surgery,a statistically significant improvement in curvature degree(p<0.05)and satisfactory penile appearance(p<0.05)were seen in both groups without any superiority between the two groups(p=0.423 and p=0.840,respectively).With a 30-month follow-up,the IIEF-5 was consistent in both groups,with no statistical significance between the groups(p=0.492).The main change in penile length during the operation was increased and still positive in the last follow-up in both groups without statistical significance(p=0.255 and p=0.101,respectively).Conclusion:Partial plaque excision and corporoplasty with both testicular tunica vaginalis or bovine pericardium grafts are equally effective in treating males with clinically significant PD.

Modified unilateral periureteral injection technique in the treatment of patients with high-grade vesicoureteral reflux: A study of primary findings

Objective:Although endoscopic treatment has been used by many pediatric urologists for the treatment of vesicoureteral reflux(VUR),it has no considerable success in high-grade VUR.We aimed to describe the primary outcomes of unilateral periureteral injection technique(PIT),as well as bilateral PIT in high-grade VUR.Methods:In this prospective study,we examined 92 ureters in 45 boys and 40 girls from February 2010 to May 2018.Bilateral PIT and unilateral PIT were applied in 67 and 25 refluxing units,respectively.In the unilateral PIT,the subureteral injection site was only at the 5-or 7-o’clock position.However,in the bilateral PIT,the subureteral injection sites were at 5-and 7-o’clock position.Pre-and post-operative reflux grades were evaluated by voiding cystourethrography 6 months after surgery.Results:Seven patients had bilateral reflux.Overall,75(81.5%)ureters showed Grade IV VUR,while 17(18.5%)had primary Grade V VUR.The mean age of the subjects was 39.2 months.In unilateral PIT ureters,VUR was resolved in 23(92.0%)refluxing units.It was downgraded to Grade III in one ureter(4.0%)and to Grade II in another ureter(4.0%).In addition,in bilateral PIT cases,VUR was resolved in 60(89.6%)ureters;it downgraded to Grades II and III in 3(4.5%)and 4(6.0%)refluxing units,respectively.Conclusion:Unilateral PIT can be highly effective in the treatment of selected ureters of high-grade VUR.However,further studies are needed to confirm our results.

经直肠超声引导自动活检枪前列腺穿刺260例分析

目的 :研究经直肠超声引导自动活检枪前列腺穿刺在诊断早期前列腺癌方面的意义。方法 :患者分为两组 ,第 1组 2 30例为经每年一次 PSA筛选 ,PSA>4μg/ L而进行直肠指检 (DRE)和经直肠超声引导自动活检枪穿刺 (TRU S)加活检的澳大利亚患者 ;第 2组 30例为 DRE有可疑结节而进行 TRUS加活检的国内病例。结果 :经直肠超声引导自动活检枪前列腺穿刺所获标本取材全部优良 ,符合病理诊断的要求。第 1组检出前列腺癌82例 ,其中 T2 a期以内 80例 ,T2 b 2例 ,不典型增生 19例 ;第 2组检出前列腺癌 8例 ,其中 1例属 T2 b,已行根治性前列腺切除术 ,另外 7例至少在 T3期以上。所有患者穿刺后未发生严重并发症。结论 :经直肠超声引导自动活检枪前列腺穿刺是确诊早期前列腺癌的重要的方法 ,而且并发症少 ,值得推广。

The influence of prostate volume on cancer detection in the Chinese population

In western populations, prostate volume （PV） has been proven to be one of the strongest predictors of detecting prostate cancer （PCa） in biopsies. We performed this study in a biopsy cohort, to evaluate associations among the prostate volume, prostate-specific antigen （PSA） and PCa detection in the Chinese population. Between the years, 2007-13, 1486 men underwent prostate biopsy at Huashan Hospital, Fudan University, Shanghai, China. The study population was divided into two groups for analysis according to total PSA （tPSA） range （4 ng m1-1 〈tPSA 〈20 ng m1-1 and tPSA 〉20 ng ml-1）. PV, age, tPSA, digital rectal examination （DRE） and transrectal ultrasound （TRUS） results were also included in the analysis. Although the positive biopsy rates decreased in both tPSA range groups, the downtrend was more pronounced in the 4 ng ml-2 〈tPSA 〈20 ng m1-1 group; therefore, we focused on 853 men in this group with increasing PV. In multivariate logistic regression analysis, only DRE was found to be associated with PCa in four PV groups （P 〈 0.05） and tPSA did not show a good predictive ability when PV exceeded 50 ml （P 〉 0.05）. Further, it may suggest that with increasing PV, the cancer detection rate decreased in men with different tPSA, DRE and TRUS nodule statuses （all P values for trends were 〈0.001）. Our study indicates that in tPSA ranging from 4 to 20 ng ml-1, the use of PV ranges of 0-35 ml, 35-50 ml and 〉50 ml might be taken into consideration for the biopsy decision-making in the Chinese population.

Effect of stone composition,color,size,impaction and location on the efficacy of pneumatic ureterolithotripsy

Objective:Assessment of the relationship between stone location,composition,color,size and impaction with success rate of pneumatic ureterolithotripsy.Methods:This study was performed on 440 patients who were candidate for pneumatic ureterolithotripsy admitted in an academic urology department from February 2004 to June 2006.Exclusion criteria included active urinary tract infection and pregnancy.Information such as stone composition,color,impaction,size,location and surface were recorded.Success rate was defined as stone fragmentation to < 2 mm.We used chi-square test and student t-test for statistical analysis.Results:The success rate of pneumatic ureterolithotripsy was 83.0 %.Mean stone size was 9.86 ± 3.79 mm.The stone free rates in upper,middle and lower ureter were 66.7 %,100 % and 90.7 % respectively(P<0.000 1).Stone free rate was 100 % and 69.35 % in <5 mm and >5 mm stones respectively(P<0.000 1).Impaction did not correlate significantly with stone free rate(P=0.17).The success rate was 100 % in phosphate and cystine stones.There was a significant statistical difference between success rate and stone composition(P=0.026).The most common fragmented stone color was gold(95.5 %).Stone color correlated significantly with stone free rate(P<0.000 1).Conclusion:In this series ureterolithotripsy,stone free rate had a significant correlation with stone color,size,composition and location,but it was independent of stone impaction.

Relationship study between platelet count and stage and grade of renal cell carcinoma in indoor patients

Objective:Thrombocytosis has been reported in many types of malignancies and has been studied as a prognostic factor.The aim of this survey is to investigate the relation between platelet count and stage and grade of tumor in indoor patients with renal cell carcinoma(RCC)in order to evaluate the prognostic value of thrombocytosis.Methods:In a descriptive and retrospective survey 82 patients treated by radical nephrectomy for RCC were enrolled.In all cases TNM stage,Fuhrman grade,invasion and platelet count were recorded and entered in SPSS software for analysis.Results:In this study,76 patients(92.7 %)with normal platelet and 6 patients(7.3 %)with thrombocytosis were studied.In this survey there was no significant correlation between the thrombocytosis and pathological stage in all patients,both genders and various age groups.In addition,the correlation between thrombocytosis and nuclear grade was investigated and a significant correlation between them in all patients and both genders was found.Finally,there was no significant correlation between thrombocytosis and nuclear grade at various age groups.Conclusion:Prognostic indicators that can accurately predict survival rates in patients with RCC can be used to select those patients most likely to benefit from adjuvant therapy.In this survey there was a significant correlation between thrombocytosis and nuclear grade,however,further clinical studies are needed.

Assessment of Urine Analysis Diagnostic Role: A Cross-Sectional Study in South Eastern of Iran

Introduction: Testing for the presence of micro-organisms in the urinary tract, in order to diagnose asymptomatic bacteriuria or symptomatic urinary tract infections (UTI), is very common at all levels of health care. This study was conducted to assess the diagnostic values for bacteriuria and pyuria and evaluate their roles in therapeutic decision making. Methods: A total of 1770 urine samples were obtained by simple randomized method from the central Laboratory of the Ali-ebne-Abitaleb Hospital (Zahedan, Iran). Urine culture was done to compare urine microscopy profiles. Sensitivity, specificity, positive and negative predictive values of the findings of urine analysis was described. Results: 1055 (59.6%) of the cases were females. 13% (230/1770) of patients had positive urine cultures. The most prevalent cultured micro-organism was E. coli (63%). Sensitivity, specificity, positive and negative predictive values of microscopic pyuria were 85%, 88%, 51%, 97%, respectively. As the same for bacteriuria, these calculations were 97%, 98%, 90%, 99% and for the category with both bacteriuria and pyuria were 82%, 99%, 95%, 97%, respectively. Conclusion: According to the results, it is concluded that the urine microscopy features seems to be useful to exclude the presence of infection if the results of both bacteriuria and pyuria are negative, but positive test results have to be confirmed.

Trading in your spindles for blebs： the amoeboid tumor cell phenotype in prostate cancer

Prostate cancer （PCa） remains a principal cause ofmortalityin developed countries.Because no clinical interventions overcome resistance to androgen ablation therapy, management of castration resistance and metastatic disease remains largely untreatable. Metastasis is a multistep process in which tumor cells lose cell-cell contacts, egress from the primary tumor, intravasate, survive shear stress within the vasculature and extravasate into tissues to colonize ectopic sites. Tumor ceils reestablish migratory behaviors employed during nonneoplastic processes such as embryonic development, leukocyte trafficking and wound healing. While mesenchymal motility is an established paradigm of dissemination, an alternate, ＇amoeboid＇ phenotype is increasingly appreciated as relevant to human cancer.

Oncolytic viruses:A novel treatment strategy for breast cancer

Breast cancer,an unceasingly occurring neoplasm,is one of the major determinants of mortality in women.Several ineffective attempts have been pursued using with conventional therapies against breast cancer.Resistance to existing therapies and their respective debilitating adverse effects have led research toward a new era of cancer treatment using viruses.Virotherapy constitutes a developing treatment modality with multiple mechanisms of therapeutic activity in which the viruses can be directly oncolyticand can express transgenes or induce host immune response against tumor cells.Several different DNA-and RNA-containing viruses have been considered for virotherapy of breast cancer including adenovirus,herpes virus,vaccinia,reovirus,Newcastle Disease virus,measles virus and vesicular stomatitis virus.This review aims to summarize the viro-therapeutical agents against breast malignancies.Key Scientific Concepts of Review:In this review paper,we proposed a new strategy to virus's combinatorial treatments using several kinds of transgenes and drugs.These recombinant viruses have provided evidence of treatment efficacy against human breast cancer.

The Huashan risk calculators performed better in prediction of prostate cancer in Chinese population： a training study followed by a validation study

The performances of the Prostate Cancer Prevention Trial （PCPT） risk calculator and other risk calculators for prostate cancer （PCa） prediction in Chinese populations were poorly understood. We performed this study to build risk calculators （Huashan risk calculators） based on Chinese population and validated the performance of prostate-specific antigen （PSA）, PCPT risk calculator, and Huashan risk calculators in a validation cohort. We built Huashan risk calculators based on data from 1059 men who underwent initial prostate biopsy from January 2006 to December 2010 in a training cohort. Then, we validated the performance of PSA, PCPT risk calculator, and Huashan risk calculators in an observational validation study from January 2011 to December 2014. All necessary clinical information were collected before the biopsy. The results showed that Huashan risk calculators 1 and 2 outperformed the PCPT risk calculator for predicting PCa in both entire training cohort and stratified population （with PSA from 2.0 ng ml^-1 to 20.0 ng ml^-1）. In the validation study, Huashan risk calculator 1 still outperformed the PCPT risk calculator in the entire validation cohort （0.849 vs 0.779 in area under the receiver operating characteristic curve [AUC]） and stratified population. A considerable reduction of unnecessary biopsies （approximately 30%） was also observed when the Huashan risk calculators were used. Thus, we believe that the Huashan risk calculators （especially Huashan risk calculator 1） may have added value for predicting PCa in Chinese population. However, these results still needed further evaluation in larger populations.

Evaluation of PSA-age volume score in predicting prostate cancer in Chinese population

This study was performed to evaluate prostate-specific antigen-age volume （PSA-AV） scores in predicting prostate cancer （PCa） in a Chinese biopsy population. A total of 2355 men who underwent initial prostate biopsy from January 2006 to November 2015 in Huashan Hospital were recruited in the current study. The PSA-AV scores were calculated and assessed together with PSA and PSA density （PSAD） retrospectively. Among 2133 patients included in the analysis, 947 （44.4%） were diagnosed with PCa. The mean age, PSA, and positive rates of digital rectal examination result and transrectal ultrasound result were statistically higher in men diagnosed with PCa （all P 〈 0.05）. The values of area under the receiver operating characteristic curves （AUCs） of PSAD and PSA-AV were 0.864 and 0.851, respectively, in predicting PCa in the entire population, both performed better than PSA （AUC = 0.805; P 〈 0.05）. The superiority of PSAD and PSA-AV was more obvious in subgroup with PSA ranging from 2.0 ng ml^-1 to 20.0 ng ml^-1. A PSA-AV score of 400 had a sensitivity and specificity of 93.7% and 40.0%, respectively. In conclusion, the PSA-AV score performed equally with PSAD and was better than PSA in predicting PCa. This indicated that PSA-AV score could be a useful tool for predicting PCa in Chinese population.

Phi-based risk calculators performed better in the prediction of prostate cancer in the Chinese population

Risk prediction models including the Prostate Health Index(phi)for prostate cancer have been well established and evaluated in the Western population.The aim of this study is to build phi-based risk calculators in a prostate biopsy population and evaluate their performanee in predicting prostate cancer(PCa)and high-grade PCa(Gleason score 27)in the Chinese population.We developed risk calculators based on 635 men who underwent initial prostate biopsy.Then,we validated the performance of prostate-specific antigen(PSA),phi,and the risk calculators in an additional observational cohort of 1045 men.We observed that the phi-based risk calculators(risk calculators 2 and 4)outperformed the PSA-based risk calculator for predicting PCa and high-grade PCa in the training cohort.In the validation study,the area under the receiver operating characteristic curve(AUC)for risk calculators 2 and 4 reached 0.91 and 0.92,respectively,for predicting PCa and high-grade PCa,respectively;the AUC values were better than those for risk calculator 1(PSA-based model with an AUC of 0.81 and 0.82,respectively)(all P<0.001).Such superiority was also observed in the stratified population with PSA ranging from 2.0 ng ml^-1 to 10.0 ng ml^-1.Decision curves confirmed that a considerable proportion of unnecessary biopsies could be avoided while applying phi-based risk calculators.In this study,we showed that,compared to risk calculators without phi,phi-based risk calculators exhibited superior discrimination and calibration for PCa in the Chinese biopsy population.Applying these risk calculators also considerably reduced the number of unnecessary biopsies for PCa.

The prognostic value of lymphovascular invasion in radical prostatectomy, a systematic review and meta-analysis

To systematically evaluate the prognostic value of lymphovascular invasion （LVI） in radical prostatectomy （RP） by a meta-analysis based on the published literature. To identify relevant studies, PubMed, Cochrane Library, and Web of Science database were searched from 1966 to May 2014. Finally, 25 studies （9503 patients） were included. LVI was found in 12.2% （1156/9503） of the RP specimens. LVI was found to be correlated with higher pathological tumor stages （greater than pT3 stage） （risk ratio [RR] 1.90, 95% confidence interval [CI] 1.73-2.08, P〈 0.00001）, higher Gleason scores （greater than GS = 7） （RR 1.30, 95% CI 1.23-1.38, P 〈 0.00001）, positive pathological node （pN） status （RR 5.67, 95% CI 3.14-10.24, P 〈 0.00001）, extracapsular extension （RR 1.72, 95% CI 1.46-2.02, P 〈 0.00001）, and seminal vesicle involvement （RR 3.36, 95% CI 2.41-4.70, P 〈 0.00001）. The pooled hazard ratio （HR） was statistically significant for Biochemical Recurrence-Free （BCR-free） probability （HR 2.05, 95% ／ CI 1.64-2.56; Z = 6.30, P〈 0.00001）. Sensitivity analysis showed that the pooled HR and 95% CI were not significantly altered by the omission of any single study. Begg＇s Funnel plots showed no significant publication bias （P = 0.112）. In conclusion, LVI exhibited a detrimental effect on the BCR-Free probability and clinicopathological features in RP specimens, and may prove to be an independent prognostic factor of BCR.

Operative techniques of anastomotic posterior urethroplasty for traumatic posterior urethral strictures

Objective： To elucidate the details of operative technique of anastomotic posterior urethroplasty for traumatic posterior urethral strictures in attempt to offer a successful result. Methods： We reviewed the clinical data of 106 patients who had undergone anastomotic repair for posterior urethral strictures following traumatic pelvic fracture between 1979 and 2004. Patients＇ age ranged from 8 to 53 years （mean 27 years ）. Surgical repair was performed via perinea in 72 patients, modified transperineal repair in 5 and perineoabdominal repair in 29. Follow-up ranged from 1 to 23 years （ mean 8 years ）. Results： Among the 77 patients treated by perineal approaches, 69 （95.8 % ） were successfully repaired and 27 out of the 29 patients （93. 1% ） who were repaired by perineoabdominal protocols were successful. The successful results have sustained as long as 23 years in some cases.Urinary incontinence did not happen in any patients while impotence occurred as a result of the anastomotic surgery. Conclusions： Three important skills or principles will ensure a successful outcome, namely complete excision of scar tissues, a completely normal mucnsa ready for anastomosis at both ends of the urethra, and a tension-free anastomosis. When the urethral stricture is below 2. 5 cm long, restoration of urethral continuity can be accomplished by a perineal procedure. If the stricture is over 2. 5 cm long, a modified perineal or transpubic perineoabdominal procedure should be used. In the presence of a competent bladder neck, anastomotic surgery does not result in urinary incontinence. Impotence is usually related to the original trauma and rarely （5.7 % ） to urethroplasty.