Advances in ureteroscopy

Ureteroscopy (URS) is a procedure which has been constantly evolving since the development of first generation devices 40 years ago. Progress towards smaller and more sophisticated equipment has been particularly rapid in the last decade. We review the significant steps that have been made toward improving outcomes and limiting morbidity with this procedure which is central to the management of urolithiasis and other upper urinary tract pathology.     

Stone extraction with loop ureteral catheter versus ureteroscopy in small distal ureteral stones—retrospective comparison of 547 consecutive patients

BackgroundTo evaluate whether stone extraction with a loop ureteral catheter (LUC) in distal ureteral stones is associated with a higher frequency of ureteral strictures compared to treatment with primary ureteroscopic stone removal (p-URS) or ureteroscopic laser lithotripsy (l-URS).MethodsFive hundred and forty-seven consecutive patients were primarily endourologically treated for distal ureteral stones in our department between 2005 and 2019 and included in the study protocol. Data was retrospectively obtained from the patients’ charts and medical reports as well as from office-based urologists. Data analysis was performed using Fisher’s exact test, Mann-Whitney test or Student’s t-test as appropriate. A level of P<0.05 was assigned statistical significance.ResultsFour hundred and twelve patients were treated by URS (p-URS n=304, l-URS n=108) and another 135 by LUC stone extraction. Median follow-up was 41 [2–159] months. There was no difference between the groups concerning age, gender, proportion of patients with ureteral stenting, operating time, hospitalization or readmission rates. The number of ureteric strictures was small in all procedures [n=3 (1.0%) in p-URS, n=2 (1.9%) in l-URS and n=2 (1.5%) in LUC] and there was no difference between the groups concerning this serious complication (p-URS vs. LUC: P=0.6465; l-URS vs. LUC: P=0.9999).ConclusionsIn small distal stones, LUC stone extraction still is an alternative to URS procedures in stone management with comparable results concerning postinterventional ureteral strictures. In experienced hands, it still has its value in accurately selected patients.     

Combination of transurethral resection of the prostate and flexible and rigid ureteroscopy for benign prostatic hyperplasia and ureteral calculus

BackgroundCombination of transurethral resection of the prostate (TURP) and flexible and rigid ureteroscopy (URS/RIRS) is a successful approach for patients with benign prostatic hyperplasia (BPH) and ureteral calculus (UC), and the sequence is URS/RIRS followed by TURP. This research aims to compare TURP followed by URS/RIRS with URS/RIRS followed by TURP in terms of clinical efficiency and safety.MethodsFrom June 2009 to June 2021, 173 patients with BPH and upper urinary tract stones were recruited through the Harrison International Peace Hospital and were divided into intervention (TURP followed by URS/RIRS) and control groups (URS/RIRS followed by TURP). We collected demographic data, primary outcomes including urinary function, and secondary outcomes including surgical parameters and complications. SPSS 21.0 was used to analyze data.ResultsWhen comparing the surgical parameters, the intervention group showed better results than the control group regarding surgery time and length of hospitalization. When comparing urinary function and complications, there were no differences between the intervention and control groups.ConclusionsAlthough the intervention of TURP followed by URS/RIRS had similar clinical effects compared with URS/RIRS followed by TURP in the control group; the intervention saves surgery time, and decreases the length of stay and medical costs. It may therefore be a good choice for patients with BPH and UC.     

Impact of an Australian/New Zealand organisational position statement on extended-release opioid prescribing among surgical inpatients: a dual centre before-and-after study

Extended-release opioids are often prescribed to manage postoperative pain despite being difficult to titrate to analgesic requirements and their association with long-term opioid use. An Australian/New Zealand organisational position statement released in March 2018 recommended avoiding extended-release opioid prescribing for acute pain. This study aimed to evaluate the impact of this organisational position statement on extended-release opioid prescribing among surgical inpatients. Secondary objectives included predictors and clinical outcomes of prescribing extended-release opioids among surgical inpatients. We conducted a retrospective, dual centre, 11-month before-and-after study and time-series analysis by utilising electronic medical records from two teaching hospitals in Sydney, Australia. The primary outcome was the proportion of patients prescribed an extended-release opioid. For surgical patients prescribed any opioid (n = 16,284), extended-release opioid prescribing decreased after the release of the position statement (38.4% before vs. 26.6% after, p < 0.001), primarily driven by a reduction in extended-release oxycodone (31.1% before vs. 14.1% after, p < 0.001). There was a 23% immediate decline in extended-release opioid prescribing after the position statement release (p < 0.001), followed by an additional 0.2% decline per month in the following months. Multivariable regression showed that the release of the position statement was associated with a decrease in extended-release opioid prescribing (OR 0.54, 95%CI 0.50–0.58). Extended-release opioid prescribing was also associated with increased incidence of opioid-related adverse events (OR 1.52, 95%CI 1.35–1.71); length of stay (RR 1.44, 95%CI 1.39–1.51); and 28-day re-admission (OR 1.26, 95%CI 1.12–1.41). Overall, a reduction in extended-release opioid prescribing was observed in surgical inpatients following position statement release.     

补肾益髓中药复方对去卵巢骨质疏松症大鼠骨组织Runx2 mRNA及蛋白表达的影响

目的观察去卵巢骨质疏松症大鼠骨组织Runx2 mRNA及蛋白表达,探讨绝经后骨质疏松症(Postmenopausal Osteoporosis,PMOP)的发病机制以及补肾益髓中药复方的疗效机理。方法去卵巢复制骨质疏松症大鼠模型,实验设正常组、模型组、假手术组、补肾益髓中药复方组、钙尔奇D组、骨疏康组。术后7d开始灌胃给药12周。应用XR-36型双能X线骨密度仪测定股骨骨密度,应用OLYMPUS BX51显微镜观察股骨头石蜡切片HE染色显微形态结构,实时定量RT-PCR及Western Blot检测骨组织Runx2 mRNA及蛋白表达。结果 (1)与正常组、假手术组比较,模型组股骨骨密度明显降低(P0.001、P0.05),骨组织Runx2 mRNA及蛋白表达明显降低(P0.001)。(2)与模型组比较,补肾益髓中药复方组、骨疏康组股骨骨密度明显升高(P0.05),补肾益髓中药复方组(P0.001)、钙尔奇D组(P0.05)、骨疏康组(P0.01)骨组织Runx2 mRNA及蛋白表达明显上调。(3)与钙尔奇D组、骨疏康组比较,补肾益髓中药复方组骨组织Runx2 mRNA(P0.01、P0.05)及蛋白(P0.001)表达均明显升高。(4)股骨头石蜡切片HE染色显微形态结构:与正常组、假手术组比较,模型组骨小梁形态结构完整性差,有些部位破坏、断裂,余留骨重建空间较多;各给药组骨小梁形态结构均改善,结构较紧密,余留骨重建空间减少,其中以补肾益髓中药复方组改善最明显。结论骨组织Runx2 mRNA及蛋白表达降低可能是PMOP的发病机制之一;补肾益髓中药复方可能通过上调骨组织Runx2 mRNA及蛋白表达有效防治PMOP,其作用优于钙尔奇D、骨疏康。     

经皮肾镜与输尿管软镜治疗肾下盏小鹿角形结石的比较

目的比较经皮肾镜（PCNL）与输尿管软镜（FURS）治疗肾下盏小鹿角形结石的安全性及有效性。 方法回顾性纳入并分析我院2017年4月至2019年4月43例肾下盏小鹿角形结石,其中PCNL治疗20例（PCNL组）,FURS治疗23例（FURS组）,比较两组手术时间、结石清除率、手术并发症和术后住院天数等。 结果43例均顺利完成手术,PCNL组的手术时间、术后住院天数均显著长于FURS组（P<0.05）;术后1~4 d PCNL组结石清除率85.0%,显著高于FURS组52.2%,术后4周及术后半年两组结石清除率差异无统计学意义（P>0.05）,但FURS组的二次干预率更高（P<0.05）;两组在术后发热、出血及石街形成等方面差异无统计学意义（P>0.05）,但PCNL组的血红蛋白丢失量及术后止痛药使用率更高（P<0.05）。 结论PCNL与FURS在治疗肾下盏小鹿角形结石均安全、有效,两者远期疗效相当,但FURS比PCNL创伤更小,术后恢复更快,值得临床推广。     

利用共表达网络分析寻找肝细胞肿瘤术后复发分子标记物

目的 结合肝细胞肿瘤（hepatocellular carcinoma,HCC）患者的表达谱数据和基因共表达网络分析,寻找HCC术后复发相关的分子标记物.方法 筛选35/41例术后复发/未复发患者的表达谱数据的差异表达基因,然后建立基因共表达网络;利用MCODE软件寻找网络中基因共表达模块以及核心基因;最后,利用三种交叉验证方法[留一交叉验证（LOOCV）、十折交叉验证（10 fold CV）以及蒙特卡罗交叉验证（MCCV）]证明核心基因的分类能力.结果 差异表达基因筛选得到316个差异基因,共表达网络分析得到了包括84个基因的网络,MCODE软件分析得到两个基因模块及其核心基因：RACGAP1和ETS2.三种交叉验证实验发现,这两个基因对HCC样本的分类结果,LOOCV：87％（86％ ～ 89％）、10 fold CV：88％（87％ ～89％）,MCCV：85％（85％ ～86％）.结论 以上结果提示,RACGAP1和ETS2基因可作为HCC术后复发的分子标记物.     

Complications to the use of vicryl-collagen dural substitute

Summary The authors describe 3 cases of postoperative infection as a complication after the use of vicryl-collagen dural substitute. The substitute had already partially dissolved 2 weeks after surgery with the remnant so densely adherent to the brain surface that it could not be removed without damaging the cortex. This was confirmed microscopically.     

LC联合LCHTD治疗胆总管结石合并胆囊结石的效果及术后胆总管结石复发的相关因素分析

目的 探讨腹腔镜胆囊切除（LC）联合腹腔镜胆总管切开取石T管引流术（LCHTD）治疗胆总管结石合并胆囊结石的效果及术后胆总管结石复发的相关因素。方法 回顾性分析2018 年1 月至2019 年1 月新疆医科大学第一附属医院93 例胆总管结石合并胆囊结石患者临床资料,所有患者均给予LC联合LCHTD治疗。根据是否术后胆总管结石复发分为结石复发组（24例）和结石未复发组（69例）,观察两组临床疗效、手术时间、术中出血量、总住院时间、住院费用,随访术后胆总管结石复发情况,分析术后胆总管结石复发的危险因素。结果 93例患者LC联合LCHTD治疗手术成功90 例,中转开腹3 例。手术时间（109.4±10.6）min,术中出血量（80.2±19.1）mL,总住院时间（9.2±1.2）d,住院费用（1.9±0.4）万元。所有患者均完成随访18个月,术后胆总管结石复发24例（25.81%）,平均复发时间为（10.3±2.1）个月。结石未复发组剔除中转开腹3 例,单因素分析表明,结石复发组和结石未复发组患者年龄、性别、病程、结石直径差异无统计学意义（P＞0.05）;胆总管结石类型、结石数量、胆总管直径、碎石术、胆总管扩张、胆囊管扩张、合并炎症与胆总管结石合并胆囊结石术后胆总管结石复发相关（P＜0.05）;多因素非条件Logistic分析显示,结石数量、胆总管直径、碎石术、胆总管扩张、胆囊管扩张、合并炎症是胆总管结石合并胆囊结石术后胆总管结石复发的独立危险因素（P＜0.05）。结论 在胆总管结石合并胆囊结石患者中应用LC联合LCHTD疗效显著,术后结石复发受多种因素影响,积极干预可有效降低结石复发率。     

Career Satisfaction, Practice Patterns and Burnout among Surgical Oncologists: Report on the Quality of Life of Members of the Society of Surgical Oncology

Background Studies show that 30–50% of medical oncologists experience burnout, but little is known about burnout among surgical oncologists. We hypothesized that wide variation in burnout and career satisfaction exist among surgical oncologists. Patients and Methods In April 2006, members of the Society of Surgical Oncology (SSO) were sent an anonymous, cross-sectional survey evaluating demographic variables, practice characteristics, career satisfaction, burnout, and quality of life (QOL). Burnout and QOL were measured using validated instruments. Results Of the 1519 surgical oncologists surveyed, 549 (36%) responded. More than 50% of respondents worked more than 60 hours per week while 24% performed more than 10 surgical cases per week. Among the respondents, 72% were academic surgical oncologists and 26% spent at least 25% of their time to research. Seventy-nine percent stated that they would become a surgical oncologist again given the choice. Overall, 28% of respondents had burnout. Burnout was more common among respondents age 50 years or younger (31% vs 22%; P = .029) and women (37% vs 26%; P = .031). Factors associated with a higher risk of burnout on multivariate analysis were devoting less than 25% of time to research, had lower physical QOL, and were age 50 years or younger. Burnout was associated with lower satisfaction with career choice. Conclusions Although surgical oncologists indicated a high level of career satisfaction, nearly a third experienced burnout. Factors associated with burnout in this study may inform efforts by program directors and SSO members to promote personal health and retain the best surgeons in the field of surgical oncology. Additional research is needed to inform evidenced-based interventions at both the individual and organizational level to reduce burnout.     

Validation of the World Health Organization/International Society of Urological Pathology grading for Chinese patients with clear cell renal cell carcinoma

BackgroundThis study aimed to compare the World Health Organization/International Society of Urological Pathology (WHO/ISUP) grading system and the Fuhrman grading system and to verify the WHO/ISUP grade as a prognostic parameter of clear cell renal cell carcinoma (ccRCC) in a Chinese population.MethodsThe study consisted of 753 ccRCC patients treated with curative surgery between 2010 and 2018 at Xiangya Hospital Central South University (Changsha, China). All pathologic data were retrospectively reviewed by two pathologists. Cancer-specific survival (CSS) and recurrence-free survival (RFS) were examined as clinical outcomes.ResultsAccording to the WHO/ISUP grading system (ISUP group), nephrectomy type, pT stage and WHO/ISUP grade were independent risk factors for CSS (P<0.0001, P=0.0127 and P<0.0001, respectively) and RFS (P<0.0001, P=0.0077, and P<0.0001, respectively). In the Fuhrman group, nephrectomy type, pT stage and Fuhrman grade were independent risk factors for CSS (P<0.0001, P=0.0004, and P<0.0001, respectively) and RFS (P<0.0001, P=0.0001, and P<0.0001, respectively). The C-index for CSS and RFS using the Fuhrman grading system was 0.6323 and 0.6342, respectively, and that using the WHO/ISUP grading system was 0.6983 and 0.7005, respectively, both higher than the former (P=0.0185, and P=0.0172, respectively). In addition, upgrading from Fuhrman grade 2 to ISUP grade 3 resulted in worse CSS and RFS for ccRCC patients (P=0.0033 and P =0.0003, respectively).ConclusionsWe first verified correlations between the postoperative prognosis and WHO/ISUP grade of ccRCC in a Chinese population and confirmed that the ability to predict clinical outcomes with the WHO/ISUP grading system was superior to that with the Fuhrman grading system.