Jian Lin

Background: Robot-assisted surgery has increasingly been applied to upper urinary tract reconstruction, offering technical advantages in selected complex cases. This bibliometric study aims to map the global research landscape, identify key contributors, and analyze emerging trends in robot-assisted upper urinary tract reconstruction. Methods: Publications related to robotic upper urinary tract reconstruction were retrieved from the Web of Science Core Collection. Bibliometric analysis was performed using R to evaluate publication trends, countries, institutions, authors, journals, and keywords. Results: A total of 1,104 publications on robotic upper urinary tract reconstruction published were included. Research output increased steadily, with rapid growth after 2020. The United States led in publications and collaboration, followed by China. The University of Chicago, New York University, and Peking University were the most productive institutions, and Journal of Endourology was the leading journal. Highly cited studies mainly focused on robotic pyeloplasty and ureteropelvic junction obstruction. Core topics included pyeloplasty, robotic surgery, pediatric reconstruction, and ureteral reimplantation. Recent trends show a shift toward complex ureteral reconstruction, with ureteroplasty, ureteral stricture, graft-based reconstruction, and single-port robotic surgery as emerging hotspots. Conclusions: Research on robotic upper urinary tract reconstruction has expanded rapidly, driven by a few leading countries and institutions. The focus has shifted from pyeloplasty and pediatric cases to more complex ureteral reconstruction. Emerging areas such as ureteroplasty, graft-based techniques, and single-port surgery are expected to shape future developments.

Objectives: Coronavirus disease 2019 (COVID-19) poses a significant threat to kidney transplant recipients (KTRs) due to chronic immunosuppression. While Azvudine has demonstrated antiviral efficacy, its long-term impact on allograft function in KTRs remains unknown. This single-arm retrospective study provides a comprehensive evaluation of the outcomes. Methods: This single-center, retrospective study consecutively enrolled 20 KTRs diagnosed with COVID-19 during the Omicron surge (December 2022–January 2023), all treated with an Azvudine-centered regimen. Clinical data, treatment responses, and serial renal function parameters were analyzed. Long-term follow-up extended to a median of 39 months. Results: The median time to COVID-19 nucleic acid negativity was 13.22 days. Renal function improved significantly during treatment: estimated glomerular filtration rate increased by a mean of 27.29 mL/min/1.73 m², and serum creatinine decreased by 57.72 µmol/L (both p < 0.01). Common complications included electrolyte imbalances and co-infections (50% of patients). Crucially, at a median follow-up of 39 months, 75% (15/20) of patients maintained normal allograft function. No Azvudine-related adverse events or drug interactions with immunosuppressants were observed. Conclusions: While acknowledging the inherent limitations of a non-comparative design, this study provides preliminary evidence suggesting that an Azvudine-centered regimen may be associated with promising efficacy, a favorable safety profile without interference with immunosuppressive therapy, and—most importantly—durable renal allograft survival in KTRs with COVID-19. Our data suggest that this regimen could contribute to mitigating the long-term risk of allograft dysfunction, potentially bringing outcomes closer to the expected baseline for stable recipients. Coupled with its low risk of drug–drug interactions, potential immunomodulatory benefits, and superior cost-effectiveness, Azvudine could be considered a valuable therapeutic option for this high-risk population in the post-pandemic era, although these findings warrant cautious interpretation. Controlled trials are ultimately needed to confirm these observations.

To investigate the differential efficacy and safety profiles of oral mucosa (OM) grafts compared with acellular dermal matrix (ADM) grafts in the surgical management of long-segment urethral strictures. A retrospective cohort study was conducted involving 27 patients who underwent graft urethroplasty for long-segment urethral strictures in Peking University First Hospital, spanning from May 2010 to September 2023. The patient cohort comprised 14 individuals who received OM grafts and 13 who underwent ADM grafts. The participants were stratified into two groups based on the type of grafts material utilized during surgery. The demographic and clinical baseline characteristics included an average age of (43.3±14.0) years in the OM group and (54.2±15.9) years in the ADM group. The mean body mass index (BMI) for the respective groups were (24.7±4.3) kg/m² for OM and (25.4±4.8) kg/m² for ADM. Etiological differences were noted, with idiopathic causes predominantly in the OM cohort and lichen sclerosus in the ADM cohort. The surgical interventions were successfully executed for all the patients. The median stricture length was 4.5 (2.5, 9.0) cm for the OM group and 5.0 (2.0, 14.0) cm for the ADM group (P=0.555). The median operative duration was 160 (71, 221) min for the OM group and 134 (112, 274) min for the ADM group (P=0.065). The catheterization durations was 1.5 (1.0, 6.0) months for the OM group and 3.0 (1.0, 3.0) months for the ADM group. The median postoperative follow-up duration was 12.5 (1.0, 170.0) months for the OM group and 59.0 (3.0, 142.0) months for the ADM group. The surgical success rates were 50.00% in the OM group and 53.85% in the ADM group. No statistically significant differences were observed in postoperative quality of life (QoL) or international prostate symptom score (IPSS) at the final follow-up. The stricture-free survival rates did not differ significantly (HR=0.875, 95%CI: 0.507-1.511, P=0.6). In terms of safety, three patients in the OM group experienced sexual dysfunction, and two had oral complications, whereas the ADM group had one case of postoperative infection. The findings suggest that ADM grafts are comparable to OM grafts in terms of efficacy and safety for the treatment of long-segment urethral strictures, including complex cases attributed to lichen sclerosus. However, given the small sample size of this study, the above conclusions may have certain limitations. Larger cohort studies will be needed in the future to further validate these findings.

The treatment of urethral stricture disease and the prevention of restenosis present considerable challenges in the field of urology. Tissue-engineered materials, particularly bacterial cellulose scaffolds, have emerged as promising solutions due to their abundant sources, excellent mechanical properties, and biocompatibility. However, for attaining superior treatment for patients with USD, further modification of bacterial cellulose is necessary. We have fabricated a dual-network scaffold with enhanced antibacterial properties and cytokines absorption ability through in-situ polymerization of cationic polyurethane micelles and cyclodextrin on oxidized bacterial cellulose. This scaffold also enables long-term sustained release of loaded drug components. Animal model studies have confirmed that this scaffold can achieve urethral repair outcomes comparable to those of normal urethral tissue. This innovative material provides a robust foundation for advancing new concepts and methodologies in the treatment of urethral stricture disease, potentially transforming clinical approaches to this challenging condition.

Background: The treatment of urethral stricture, particularly long-segment urethral stricture, poses a significant challenge in urological reconstruction. High-pressure balloon dilation has gained widespread recognition as an effective and safe therapeutic option. However, studies on its long-term outcomes, especially for long-segment urethral stricture, remain scarce. This study aims to establish the clinical baseline efficacy and safety of urethral balloon dilation at a tertiary care center and to provide context through an exploratory comparison with a contemporaneous cohort treated with direct vision internal urethrotomy (DVIU)/dilation. Methods: There were 128 patients with urethral strictures who underwent endoluminal treatment at our center between November 2017 and September 2023. Of these 128 patients, 64 underwent balloon dilation and 64 underwent DVIU/dilation. Demographic and stricture characteristics data were collected. The endpoint was defined as the recurrence of strictures requiring intervention. The efficacy and safety of balloon dilation were analyzed, including outcomes by stricture length within the balloon dilation group. Comparative outcomes with the DVIU/dilation group were explored cautiously due to baseline differences. Results: The median follow-up duration was 26 months for the balloon dilation group and 43 months for the DVIU/dilation group. Patients in the balloon dilation group generally had more complex strictures. The overall 1-year success rate for balloon dilation was 70.1%. Within the balloon dilation group, the 1-year success rate for long-segment strictures (≥2 cm) was 70.0%, and for short-segment strictures (Conclusions: Balloon dilation represents an effective and safe method for the management of both short and long-segment urethral strictures. These findings establish a valuable clinical baseline for conventional balloon dilation.

Background: Urethral stricture represents a prevalent clinical entity in urological practice, with urethroplasty currently serving as the primary therapeutic approach for complex cases. This study aimed to analyze the efficacy of urethral stricture resection and primary end-to-end anastomosis for treating male urethral strictures and identify potential risk factors for postoperative recurrence. Methods: A retrospective analysis was conducted on 37 male patients who underwent this procedure at Peking University First Hospital between February 2018 and September 2024. Clinical data of the patients, including age, preoperative urinary tract infection, etiology of urethral stricture, location of urethral stricture, length of stricture segment, preoperative urethral surgery history, presence of bladder fistula, preoperative and postoperative quality of life (QoL) index, preoperative and postoperative International Prostate Symptom Scores (IPSS) score, postoperative regular dilation, and postoperative complications, were collected and analyzed using statistical methods. Results: The median follow-up time for the patients was 57 [interquartile range (IQR), 39.5–66.5] months, and the stricture length was 20 (IQR, 10–30) mm. The rate of recurrent stricture was 40.54% (15/37), with a median time from surgery to recurrence of 3 (IQR, 1–6) months. The preoperative and postoperative QoL and IPSS scores showed significant differences (PConclusions: We provided clinical information on stricture resection and end-to-end anastomosis in the treatment of male urethral strictures, providing a baseline reference for relevant research. Individualized assessment and management are crucial for improving surgical success rates and patient QoL.