Kai Zhang

To compare perioperative and follow-up outcomes of ileal ureter replacement (IUR) among open (O-IUR), laparoscopic (L-IUR) and robotic (R-IUR) approaches. We conducted a bidirectional cohort study of patients undergoing IUR for long ureteral strictures between September 2010 and April 2023 in our multi-institutional database. Clinical and follow-up outcomes were compared among the O-IUR, L-IUR and R-IUR groups. Clinical success was defined as symptom-free, stable renal function and no radiographic evidence of obstruction. Among 106 patients (23 in O-IUR, 49 in L-IUR and 34 in R-IUR), the three groups had comparable demographic and baseline characteristics. The median operation time was significantly shorter in R-IUR compared to O-IUR (p = 0.029) and L-IUR (p < 0.001). The median estimated blood loss was statistically lower in R-IUR compared to O-IUR (p = 0.002) and L-IUR (p < 0.001). The median length of stay was statistically shorter in R-IUR compared to O-IUR (p < 0.001) and L-IUR (p < 0.001). The rate of postoperative Clavien-Dindo grade III complications was higher in O-IUR compared to L-IUR (p = 0.257) and R-IUR (p = 0.022). Robotic ileal ureter replacement demonstrates clear perioperative advantages, consistent with the well-established superiority of robotic platforms in complex reconstructive procedures. However, differences in follow-up duration and potential time/experience bias should be acknowledged when interpreting complication rates.

Purpose Urge urinary incontinence (UUI) frequently coexists with bladder outlet obstruction (BOO) in men with benign prostatic hyperplasia (BPH), yet its postoperative course following thulium laser enucleation of the prostate (ThuLEP) remains insufficiently characterized. This study evaluated symptom recovery at 3 and 12 months after ThuLEP and identified factors associated with postoperative UUI at 3 months. Materials and methods We performed a retrospective analysis of a prospectively maintained single-center database including 629 men who underwent ThuLEP between January 2021 and December 2024. UUI was defined as Overactive Bladder Symptom Score item 4 ≥ 1 combined with International Consultation on Incontinence Questionnaire–Short Form ≥ 1, excluding stress-predominant leakage. Symptom assessments were conducted at baseline, 3 months, and 12 months. Multivariable logistic regression identified factors associated with postoperative UUI at 3 months. Results Preoperative UUI was present in 217 patients (34.49%). These patients exhibited significantly greater storage symptom burden but similar prostate volume and intravesical prostatic protrusion. At 3 months, both groups showed marked improvement in voiding function and overall symptom scores; however, postoperative UUI remained more frequent in those with preoperative UUI. By 12 months, overall LUTS severity was comparable between groups, with only mild residual differences in OABSS-4. Among patients with preoperative UUI, baseline OABSS, ICIQ-SF, and maximum urinary flow rate were independently associated with postoperative UUI at 3 months. Conclusions Preoperative UUI is common among men undergoing ThuLEP and is associated with greater storage symptom burden. Although early postoperative UUI is more frequent in these patients, both voiding and storage symptoms improve substantially and remain relatively stable over time.

This study aimed to investigate the risk factors for postoperative complications following transurethral thulium laser enucleation of the prostate (ThuLEP) and provide references for reducing the occurrence of postoperative complications. A retrospective analysis was conducted on 103 patients with benign prostate hyperplasia who underwent ThuLEP from September 2020 to August 2022. Among them, 95 patients had complete clinical and follow-up data. Clinical data and follow-up information of the patients were collected. Univariate and multivariate logistic regression analyses were performed to identify the influencing factors of postoperative complications following ThuLEP. The incidence of postoperative complications following ThuLEP was 11.58% (11/95), among which the rates of Grade I, II, and III complications were 3.16% (3/95), 3.16% (3/95), and 5.29% (5/95), respectively. The prostate volume after ThuLEP was 96.11 ± 43.38 ml in the uncomplication group and 139.71 ± 96.41 ml in the complication group, and there was a statistically significant difference between the 2 groups ( P = .02). The prostate mass after ThuLEP was 46.99 ± 22.14 ml in the uncomplication group and 70.25 ± 41.37 ml in the complication group, and there was a statistically significant difference between the 2 groups ( P = .01). The postoperative catheter removal time after ThuLEP was 3 ± 1.04 days in the uncomplication group and 2 ± 1.49 days in the complication group, and there was a statistically significant difference between the 2 groups ( P = .02).Univariate and multivariate logistic regression analyses revealed that the postoperative catheter removal time ( P = .046) was an independent risk factor for Grade II-III complications after ThuLEP. Prostate volume and prostate mass are influencing factors for postoperative complications following ThuLEP. Postoperative catheter removal time is an independent risk factor for postoperative complications following ThuLEP.

To evaluate the safety and efficacy of a newly developed catheter coated with antimicrobial poly-L-lysine (PLL) in reducing the risk of catheter-associated

To present the initial experience and clinical outcomes of ileal ureteric replacement (IUR) for complex ureteral stricture after treatment failure of Alliu

To evaluate the effectiveness and safety of thulium fiber laser enucleation of the prostate (ThuFLEP) in the treatment of oversized (>200 mL) prostate. Clinical data of 475 benign prostatic hyperplasia (BPH) patients operated by the same urologist at Peking University First Hospital from January 2022 to May 2024 were retrospectively analyzed, all of whom were treated with thulium fiber laser, and the patients were divided into three groups according to the total volume of the prostate (TPV): group A (TPV < 100 mL), group B (100 mL≤TPV < 200 mL), and group C (TPV≥200 mL). The age of the patients in the three groups [(69.38±7.79) years, (69.64±8.69) years, (70.32±7.44) years], International Prostate Symptom Score (IPSS) [(22.7±1.9), (22.8±2.7), (25.8±3.7)], and the maximum urinary flow rate (Qmax) [(7.9±2.7) mL/s, (9.3±4.3) mL/s, (9.9±3.3) mL/s] were not statistically significant (P>0.05). The prostate volume in the three groups [(103.49±46.19) mL, (75.73±30.69) mL, (273.49±49.19) mL] and prostate specific antigen (PSA) [3.52 (1.05, 8.76) μg/L, 6.78 (1.61, 7.45) μg/L, 8.52 (5.05, 12.76) μg/L] were statistically significant (P < 0.05). All surgeries were successfully completed. The dif-ferences in enucleation time [30.0 (21.2, 44.5) min, 41.6 (31.2, 52.5) min, 45.1 (35.2, 50.0) min] and hospitalization time [(6.06±1.21) d, (6.15±1.50) d, (7.71±1.74) d] among the three groups were not statistically significant (P>0.05); and the differences in the postoperative indwelling catheter time [(4.0±1.4) d, (4.0±1.3) d, (6.6±1.1) d], operative time [61 (42, 89) min, 82 (62, 105) min, 115 (96, 142) min], enucleation efficiency [1.29 (0.71, 1.56) g/min, 1.67 (1.23, 2.15) g/min, 2.74 (2.20, 3.34) g/min], and hemoglobin drop values [12 (7, 19) g/L, 17 (11, 24) g/L, 27 (19, 35) g/L] were statistically different (P < 0.05). Linear regression ana-lysis was used to show a strong positive linear correlation between enucleation efficiency and enucleation weight (r=0.880, P < 0.001), and the enucleation efficiency increased with the increase of prostate volume. The differences in IPSS [(6.6±1.7), (6.2±1.4), (4.6±1.1)] and Qmax [(18.9±3.1) mL/s, (16.8±3.8) mL/s, (22.9±7.1) mL/s] were not statistically significant among the three groups (P>0.05), and the differences in IPSS and Qmax were statistically significant compared with those before surgery. The differences were statistically significant in preoperative comparisons, but the postoperative urinary flow rate of group C increased significantly more than the remaining two groups in terms of Qmax (P < 0.05). The patients in the three groups were followed up for 3 months, and post-operative complications were categorized into Clavien-Dindo Ⅰ (urinary retention, persistent hematu-ria), Clavien-Dindo Ⅱ (glandular remnants, urinary tract infection, blood transfusion) and Clavien-Dindo Ⅲ (urethral stenosis, contracture of the bladder neck, and reoperation for hemorrhage) based on the Clavien-Dindo Complications System score, the incidence of Clavien-Dindo in the three groups was 5.2% (13 cases), 6.7% (12 cases) and 12.1% (7 cases), respectively, with statistically significant differences (P < 0.05); among them, there were statistically significant differences in urinary infection, blood transfusion and bleeding reoperation (P < 0.05), and there was no statistically significant difference in the remaining complications (P>0.05). The risk of blood transfusion and re-hemostasis increases with larger prostate volume, the efficiency of enucleation increases with the increase of prostate vo-lume, and thulium fiber laser prostate enucleation is safe and effective in the treatment of large-volume BPH.

Purpose: To explore a novel biopsy scheme for prostate cancer (PCa), and test the detection rate and pathological agreement of standard systematic (SB) + targeted (TB) biopsy and novel biopsy scheme. Methods: Positive needles were collected from 194 patients who underwent SB + TB (STB) followed by radical prostatectomy (RP). Our novel biopsy scheme, targeted and regional systematic biopsy (TrSB) was defined as TB + regional SB (4 SB-needles closest to the TB-needles). The McNemar test was utilized to compare the detection rate performance for clinical significant PCa (csPCa) and clinical insignificant PCa (ciPCa). Moreover, the accuracy, positive predictive value (PPV) and negative predictive value (NPV) were investigated. The agreement between the different biopsy schemes grade group (GG) and RP GG were assessed. The concordance between the biopsy and the RP GG was evaluated using weighted κ coefficient analyses. Results: In this study, the overall detection rate for csPCa was 83.5% (162 of 194) when SB and TB were combined. TrSB showed better NPV than TB (97.0% vs. 74.4%). Comparing to STB, the TB-detection rate of csPCa had a significant difference (p < 0.01), while TrSB showed no significant difference (p > 0.999). For ciPCa, the overall detection rate was 16.5% (32 of 194). TrSB showed better PPV (96.6% vs. 83.3%) and NPV (97.6% vs. 92.9%) than TB. Comparing to STB, the detection rate of both schemes showed no significant difference (p = 0.077 and p = 0.375). All three schemes GG showed poor agreement with RP GG (TB: 43.3%, TrSB: 46.4%, STB: 45.9%). Using weighted κ, all three schemes showed no difference (TB: 0.48, TrSB: 0.51, STB: 0.51). In our subgroup analysis (PI-RADS = 4/5, n = 154), all three schemes almost showed no difference (Weighted κ: TB-0.50, TrSB-0.51, STB-0.50). Conclusion: Our novel biopsy scheme TrSB (TB + 4 closest SB needles) may reduce 8 cores of biopsy compared with STB (standard SB + TB), which also showed better csPCa detection rate than TB only, but the same as STB. The pathological agreement between three different biopsy schemes (TB/TrSB/STB) GG and RP GG showed no difference.

Introduction: The aim of this study was to present the surgical technique and clinical outcomes of modified ileal conduit for pelvic lipomatosis (PL). Methods: From 2020 to 2022, we prospectively enrolled 9 patients with PL undergoing modified ileal conduit. The patient characteristics, perioperative variables, and follow-up outcomes as well as the description of surgical technique were reported. Results: All 9 patients successfully completed the operation. Two patients had perioperative complications of Clavien-Dindo grade I. The mean operation time and bleeding volumes were 253 ± 51.4 min and 238.9 ± 196.9 mL, with a mean postoperative follow-up time of 13.0 ± 5.6 months. The postoperative 3-month and 1-year creatinine values were significantly decreased versus the preoperative (p = 0.006 and p = 0.024). The postoperative 3-month and 1-year estimated glomerular filtration rate values were significantly increased compared with those before operation (p = 0.0002 and p = 0.018). The separation value of left renal pelvis collection system after operation was significantly reduced compared with preoperative evaluation (p = 0.023 at 3 months and p = 0.042 at 1 year) and so was the right side (p = 0.019 and p = 0.023). Conclusion: Modified ileal conduit is safe and feasible for PL. A large sample cohort with long-term follow-up is needed to evaluate the clinical outcomes of PL.

Purpose To present our initial experience in the management of multiple ureteral polyps with robotic or laparoscopic ileal ureter replacement (IUR). Methods Eight consecutive patients diagnosed with multiple ureteral polyps underwent robotic or laparoscopic IUR between July 2019 and November 2022. Unilateral IUR was performed in 5 patients with polyps in the left (n = 3) or right (n = 2) side, and 3 patients with bilateral multiple polyps underwent bilateral IUR. Demographic characteristics, perioperative data and follow-up outcomes were prospectively collected. Results A cohort of 5 male and 3 female patients (11 ureters) with a mean age of 32.8 ± 11.3 years were included. Among these patients, 5 presented with recurrent flank pain, 1 had hematuria, and 2 were asymptomatic. Four patients experienced prior failed surgical interventions. The mean length of diseased ureter was 11.9 ± 4.7 cm, with more than 10 cm in eight sides. All procedures were performed successfully. The mean operation time was 319 ± 87.6 min with 3 patients who simultaneously underwent intraoperative ureteroscopy. The mean length of ileal graft was 23.8 ± 5.8 cm. During the mean follow-up of 20.4 ± 12.8 months, one major complication, specifically incision infection, and four minor complications, including urinary infection (n = 3) and metabolic acidosis (n = 1), were observed. All patients presented symptom-free, with improved/stabilized hydronephrosis and no signs of restenosis. Conclusion Robotic or laparoscopic IUR is a feasible, safe, and effective surgical option for patients with long ureteral defects caused by multiple polyps.