Abstract:Gene sequence technology has rapidly developed with the concept of ‘precise medical treatment’ in recent years. It explains the classical concepts of genetics，developmental biology，evolutionary biology and other disciplines from the perspective of genomic mechanisms. New concepts such as high-order chromosome conformation，cellular heterogeneity，and functional modules are extended at the genome level by it，which also opens up new fields of application for precision medicine.

Abstract:

Abstract:Objective：To investigate the influence of the change of glucose concentration on ‘LL-37 sustained-release BWPU mem－brane’ in inhibiting the formation of the BF of urinary pathogenic ESBLs producing E.coli. Methods：Urinary pathogenic ESBLs pro－ducing E.coli isolates（E44） and standard strains ATCC25922（E0） were collected. Dynamic simulated bladder BF model was adopted. ‘Two-step approach’ was adopted to prepare new LDI-BWPU emulsion PCLPU33. ‘Physical dissolution and air-drying’ loading technique was adopted to prepare LL-37 sustained-release BWPU membrane.H group：high peptide（LL-37，2000 ?滋g/mL），L group：low peptide group（LL-37，250 ?滋g/mL），P group：positive control（Imipenem，8 ?滋g/mL），and N group：negative control（without antibacterial drug） were set up to incubate under artificial urine environment for 48hours. The influence of different glucose concen－trations（0，11.1，33.3 mmol/L），control of glucose concentration（33.3→0 mmol/L） on LL-37 sustained-release BWPU membrane in inhibiting BF were observed. The detection methods included viable bacteria count method. Syto-9/P fluorescent staining，combined with laser scanning confocal microscope，was applied to construct a space diagram to measure the BF thickness. Scan－ning electron microscope was adopted to observe the microscopic view of BF structure. One-way analysis of variance（ANOVA） was adopted in viable bacteria count，BF thickness and comparison of means of multiple groups. Results：For the observation point of different glucose concentration under the constantly infected artificial urine environment，the viable bacteria count and BF thickness of P group，H group，and L group were significantly decreased than that of N group（aP=0.000）. The viable bacteria count of group H was significantly decreased than that of L group（bP=0.000）in the glucose-free environment（G0 mmol/L）,and there was no statistical dif－ference between the H and L group in the glucose-containing environment（G11.1，33.3 mmol/L）（P＞0.01）；The BF thickness of the H group was significantly decreased than that of L group at the observation point of different glucose concentration（bP=0.000）. With the increase of glucose concentration，the viable bacteria count and BF thickness of the H and L groups，increased significantly（cP=0.000）. When glucose concentration was controlled（33.3→0 mmol/L） in the H and L groups，the viable bacteria count and BF thickness were were significantly decreased（dP=0.000）. Conclusion：When the glucose concentration is different under the constantly infected artificial urine environment，LL-37 sustained-release BWPU membrane can inhibit BF growth，kill BF bacteria and signifi－cantly inhibit BF formation.

Abstract:Objective：To determine whether augmenter of liver regeneration（ALR） attenuated acute kidney injury（AKI） in rats follow－ing intramuscular injection of glycerol and to investigate the possible mechanism. Methods：The therapeutic effect of recombinant hu－man ALR（rhALR，100 mg/kg） on AKI was investigated in a glycerol（50% glycerol saline，10 mL/kg）-induced rhabdomyolysis model of AKI in rats. Male sprague dawley rats were randomly assigned to normal，AKI，or AKI+ALR groups. Renal function，creatine kinase（CK） and renal histology were to checked to determine the extent of renal damage. The expression of proliferating cell nuclear anti－gen（PCNA） was assayed to evaluate cell proliferation. Malondialdehyde（MDA），superoxide dismutase（SOD） and reduced glutathione（GSH） activities were monitored to evaluate oxidative stress. Results：Glycerol treatment induced renal function impairment（BUN and Scr were both increased），CK increase and structural abnormalities including tubular necrosis，cast formation，brush border loss，and interstitial edema. SOD activity and GSH in the kidney decreased，while MDA in the kidney increased in AKI group. A compensatory increase of PCNA was detected in AKI group. ALR had no detectable effects on normal rat kidneys，but it significantly improved renal function and alleviated pathological damage and oxidative stress in glycerol induced acute injured kidneys（AKI+ALR groups）. Renal expression of PCNA also increased in AKI+ALR group compared with that of AKI group. Conclusion：ALR significantly attenuates glycerol-induced AKI. The renal protective effects are associated with the inhibition of oxidative stress and the promotion of renal tubular epithelial cell proliferation.

Abstract:Objective：To observe the protective effect of bone morphogenetic protein 7 on TGF-β1 induced epithelial-mesenchymal transition of podocyte. Methods：The pcDNA 3.1rh BMP-7 plasmid was constructed and identified. Human podocytes were cultured in vitro，with different concentrations（10，20，50，100，200 μg/mL） of recombinant BMP-7 stimulating podocytes for 24，48，72 h and were collected in the cell respectively. The death rates of cells were detected by flow cytometry，and the optimal stimulation concen－trations and time points of recombinant BMP-7 were selected. The experiment was divided into normal control group，TGF beta 1 stimulation group（TGF-β1） and plasmid transfection group（PEGF-BMP）. PEGF-BMP group was transfected podocyte with 100 μg/mL recombinant BMP-7 pretreatment after 48 hours；the human podocytes of TGF-β1 and PEGF-BMP groups were stimulated respectively with 5 ng/mL TGF-β1. Alterations of specific markers in cultured podocytes were observed by immunofluorescence；and 72 hours after treatment，the cells of different groups were harvested，the mRNA expressions of Podocin，SMA，VIM in podocyte were detected by RT-PCR and the protein expressions of Podocin，SMA，VIM in podocyte were detected by Western blot. Results：①pcDNA 3.1rh BMP-7 plasmid was constructed successfully and stably expressed BMP-7 was transfected in human podocytes. The expression level of BMP-7 protein in PEGF-BMP group（0.487±0.012） was significantly higher than that in normal control group（0.251±0.012） and TGF beta induction group（0.151±0.015）（P<0.001）. ②Real-time PCR analysis showed that mRNA expression of podocin was significantly decreased in TGF beta 1 group（0.285±0.013） than in normal control group （1.057±0.090）（P<0.001），while mRNA expression of podocyte was increased in PEGF-BMP-7 group（0.693±0.077） than in TGF beta 1 group（P=0.003）；the mRNA expression of α-SMA，VIM were significantly increased in TGF beta 1 group（1.257±0.039，1.114±0.097） and PEGF-BMP-7 group（1.028±0.093，0.821±0.059） than in normal control group（0.357±0.089，0.403±0.020）（P＜0.001），but mRNA expression of α-SMA，VIM were decreased in PEGF-BMP group than in TGF beta 1 group（P=0.011，P=0.002）. Western blot showed that protein expression of podocin was significantly decreased in TGF beta 1 group（32.923±5.301） than in normal control group（101.807±9.208）（P<0.001），while protein expression of podocyte was increased in PEGF-BMP-7 group（90.507±7.810） than in TGF beta 1 group（P＜0.001）；the protein expression of α-SMA，VIM were significantly increased in TGF beta 1 group（116.120±8.300，124.016±9.702） and PEGF-BMP group（93.832±10.602，100.801±6.801） than in normal control group（35.730±4.892，43.801±2.600）（P＜0.001），but protein expressions of α-SMA，VIM were decreased in PEGF-BMP-7 group than in TGF beta 1 group（P=0.017，P=0.007）. Conclusion：The expression of α-SMA and VIM in human podocyte induced by TGF beta 1 was in－creased，podocin expression decreased，while BMP-7 inhibited this effect and showed the protective effect on podocyte.

Abstract:Objective：To explore the influence of inhibiting C5L2 expression on Th17 function and kidney transplantation acute rejec－tion reaction in mouse model. Methods：The C5L2 interference adenovirus was constructed，and injected into kidney transplantation acute rejection reaction mouse model by tail vein. The change of serum creatinine（Cr） was detected. Th17 related cytokines inter－leukin（IL）-6，IL-17 and tumor necrosis factor（TNF）-γ were detected by enzyme-linked immunosorbent assay（ELSA）. Kidney pathological change was detected after 1 weeks. Results：C5L2 interference adenovirus was constructed and injected into kidney transplantation acute rejection reaction mouse model successfully. In experimental group，the levels of serum Cr decreased，IL-17，IL-6 and TNF-γ were decreased. Conclusion：C5L2 interference adenovirus can inhibit the function of Th17 cells，and can reduce the kidney transplantation acute rejection reaction in mouse model.

Abstract:Objective：To investigate the protective effect and mechanism of nicotine on cold ischemia reperfusion injury in rats. Methods：Totally 30 male SD rats were randomly divided into sham operation group，IRI group and nicotine groups（40，400，4 000 ?滋g/kg），6 rats in each group. The left renal ischemia-reperfusion injury model was set up in IRI group，and the right kidney was removed. The right kidney was removed only in the sham operation group. The nicotine groups injected nicotine into the abdominal cavity before closing it，while the rest were the same as those in the IRI group. The concentrations of serum creatinine and blood urea nitrogen were determined by colorimetric method. The concentrations of interleukin-1 β（IL-1β） and tumor necrosis factor-α（TNF-α） in serum were detected by ELISA. The concentrations of nuclear factor κB（NF-κB） in cell nucleus were detected by Western blot and method of SP immunohistochemistry. HE staining was performed to observe the pathological changes of renal tissue. Results：IRI can cause pathological changes of kidney in rats，increase the level of serum creatinine（P=0.005） and blood urea nitrogen（P=0.003），increase the level of NF-κB p65（P=0.002） in the nucleus of renal tubular epithelial cells，and increase serum TNF-α（P=0.011） and IL-1β（P=0.007）. Compared with those in IRI group，the intraperitoneal injection of nicotine can reduce the content of NF-κB p65（P=0.003） in the nucleus of renal tubular epithelial cells，reduce the level of serum creatinine（P=0.005），blood urea nitrogen（P=0.004），TNF-α（P=0.009） and IL-1β（P=0.007）. But there was no significant difference between the three dose groups. Conclusion：Nicotine has protective effect on renal ischemia reperfusion injury，and its mechanism may be related to the inhibition of the nucleation of NF-κB p65 in renal tubular epithelial cells，reducing the inflammatory reaction and reducing the level of TNF-α and IL-1β.

Abstract:Objective：To investigate the effect of over or low expression of cell adhesion molecule-1（CADM1） on the malignant be－havior of human bladder cancer T24 cells. Methods：The stable expression cells of Ad-CADM1-T24，Ad-GFP1-T24，Ad-sh1-T24，Ad-GFP2-T24 were established before and were used in this study，and T24 cell was used as control. Western blot was used to detect the cell cycle-related protein p27，cyclinD1，cyclinE1，CDK2；and EMT-related protein E-cadherin，β-catenin，Vimentin；and apopto－sis-related protein caspase-3，bcl-2，bax. MTT was used to detect the cell reproductive capacity；and Transwell invasion was used to detect cell invasion ability. Results：Compared with other cells，in Ad-CADM1-T24 cell line，Western blot results showed that the ex－pressions of apoptosis-related protein caspase-3 and bax were increased，while those of bcl-2 were decreased；the expressions of cell cycle-related protein p27 were increased，while those of cyclinD1，CDK2 and cyclinE1 were decreased；the expressions of EMT-related protein E-cadherin and β-catenin were increased，while those of Vimentin were decreased. And the results of MTT showed that the cell proliferation was significantly inhibited in Ad-CADM1-T24 cell line，with statistically significant differences（P<0.05）. And the results of Transwell invasion showed that the number of cell membranes was significantly reduced in 24 h in Ad-CADM1-T24 cell line，with statistically significant differences（P<0.05）. Conclusion：Overexpression of CADM1 can significantly inhibit the invasion and metastasis of bladder cancer cells，the mechanism may be associated with inhibition of cell proliferation and EMT and promoting apoptosis.

Abstract:Objective：To establish a modified mouse kidney transplantation model with simple operation，short operation time and exact effect. Methods：The end to end anastomosis was perform on the veins，the donor kidney vena cava was evaginated after inserting catheter，and the evaginated vena cava was put into the receptor renal vein like sleeve. The abdominal aorta of the donor was anasto－mosed end-to-side to the abdominal aorta of the recipient. The donor bladder patch was anastomosed with the recipient bladder. Results：After open the blood vessels，the renal color was normal，the arterial pulsation was normal，the vein filling was good，and the kidney transplantation model of the mouse was successfully established. The venous anastomosis was （10±5） min，the arterial anas－tomosis was （10±5） min，and the bladder flap anastomosed was 2-5 min. Total operation time was 40-60 min. Conclusion：Using the modified type of venous anastomosis and the anastomosis of the bladder flap can reduce the difficulty and shorten the operation time. The mouse kidney transplantation model could be established successfully.

Abstract:Objective：To modify the S.T.O.N.E. nephrolithometry scoring system for assessing and predicting the stone-free rate（SFR） of flexible ureteroscopic lithotripsy（FURL），and to investigate the predictive value of modified S.T.O.N.E. scoring system for SFR following one-phase FURL. Methods：A literature review was performed to identify clinically relevant and reproducible variables that could affect the SFR of FURL. Five reproducible variables available from preoperative non-contrast computed tomography were measured，including stone burden（S），topography（T），obstruction（O），Number of involved calyces（N），essence of stone（E），which modified the S.T.O.N.E. nephrolithometry scoring system. A retrospective analysis was conducted clinical data of 322 patients with nephrolithiasis undergoing FURL from January 2015 to December 2017. The general conditions，preoperative information，stone characteristics and perioperative variables were collected. The correlation of modified S.T.O.N.E. scores with one-phase SFR，operation time，major complications，hospital stay were analyzed. Receiver operating characteristic（ROC） curves was drawn to detect sensitivity and specificity of modified S.T.O.N.E. scores in predicting the one-phase SFR. Results：The 322 cases’ FURLs were performed suc－cessfully，and the one-phase SFR was 88.2%. The mean modified S.T.O.N.E. score was 6.4（4 to 11） in this cohort. The one-phase SFR was 98.1% in low score（4 to 5） group of 103 cases，91.2% in medium score（6 to 8） group of 182，and 45.9% in high score（9 to 13） group of 37（χ2=74.667，P=0.000）. The modified S.T.O.N.E. score showed significant correlation with SFR following one-phase FURL（OR=5.614，95%CI=1.811 to 13.589，P=0.012），and the area under curve of ROC curves for the modified S.T.O.N.E. score was 0.802（95%CI=0.672 to 0.920），higher than that of each variables in this system. Conclusion：The modified S.T.O.N.E. nephrolithometry scoring system can predict postoperative stone-free status of one-phase FURL. Further research is required to evaluate its performance in external validation.

Abstract:Objective：To compare the safety and efficacy of flexible ureteroscopy and percutaneous nephrolithotomy in the treatment of renal stones in patients with a solitary kidney. Methods：Clinical data of 20 cases of renal stones in a solitary kidney in our hospital between March 2010 and December 2016 were retrospectively analyzed. There were 8 cases of flexible ureteroscopy（FURS） and 12 cases of percutaneous nephrolithotomy（PCNL）. The stone size，operation time，decrease of hemoglobin，incidence of complication，length of postoperative hospitalization，stone-free rate（SFR），change in serum creatinine（Scr） were compared between the two groups. Results：There was no significant difference between the FURS and PCNL groups in operation time[（104.4±23.8） min vs. （125.0±55.4） min，t=0.988，P=0.336] and length of postoperative hospitalization[（4.3±2.6） d vs. （6.0±2.8） d，t=1.429，P=0.170]. The hemoglobin was decreased more significantly in FURS group than in PCNL group[-2.0（-6.0-8.0） g/L vs. 6.0 （-3.0-14.0） g/L，Z= -2.047，P=0.041]. Perioperative complications in two groups were ClavienⅠ to Ⅱgrade，including one case of fever and one case of systemic inflammatory response syndrome in FURS group，and 3 cases of fever，one case of systemic inflammatory response syndrome and one case of blood transfusion in PCNL group. There was no significant difference between the FURS and PCNL groups in postop－erative[（163.9±108.9） μmol/L vs. （161.0±56.2） μmol/L，t=-0.076，P=0.940] and preoperative Scr[（171.6±113.4） μmol/Lvs. （152.4±65.9） μmol/L，t=-0.470，P=0.644]. The SFR of FURS and PCNL group were 62.5%（5/8） and 75.0%（9/12），respectively. Conclusion：FURS has the same safety and efficacy as PCNL in the treatment of renal stones in patients with a solitary kidney. FURS is less traumatic and bleeding. PCNL has a higher SFR especially for staghorn stones in a solitary kidney.

Abstract:Objective：To assess the efficacy and safety of flexible ureteroscopy retrograde surgery（fURS） for the treatment of uri－nary calculi over 2 cm in diameter. Methods：The data of 272 patients who underwent fURS by standard techniques for urinary cal－culi over 2 cm was collected retrospectively. Demographic，intraoperative，and postoperative data were reviewed and compared to e－valuate the efficacy and safety and to find statistically significant differences. Results：Totally 272 patients（male 188，female 84） were enrolled including 254 cases of renal stone，18 cases of upper ureteral stone and 6 cases of renal stone combined with ureteral stone，and the median age of all patients was 46.5. The cumulative stone diameter（CSD） was （34.2±9.7） mm. Overall stone free rate within 30 days was 90.5%，and overall stone free rate within 90 days was 93.8%. The incidence of complications was 10.3%，including fever in 12 cases（4.4%），steinstrasse in 2 cases（0.7%），hematuria over 24 hours in 7 cases（2.6%） and backache in 7 cases（2.6%）. Logistic regression indicated that hydronephrosis was an independent factor affecting stone clearance（95%CI=5.31 to 7 133.90，P=0.004），and the operation time was the factor affecting the complication rate（95%CI=1.030 to 1.222，P=0.008）. Conclusion：Flexible ureteroscopy is an effective and safe management method for over 2 cm urinary stones. Hydronephrosis may affect the stone free rate，and operation time may affect the complication rate.

Abstract:Objective：To investigate the risk factors of renal subcapsular hematoma after Ho：YAG laser lithotripter through flexible ureteroscope. Methods：Eleven the records of the 1 705 patients undergoing ureteroscopy and Holium laser lithotripsy for renal calculi from 2007 Janunary to 2017 December in our hospital were reviewed retrospectively. The enrolled patients including 3 males and 8 females. T test，chi-square test and multi-factor logistic regression were used to analyzed the risk factors. Results：Patients were divided into two group. All 11 patients were diagnosed by CT scan or ultrasound. Gender，urinary tract infection，hydronephrosis and manual irrigation in the operation were significant differentt in two groups. The multi-factor logistic regression analysis also showed urinary tract infection，hydronephrosis and manual irrigation in the operation were independent risk factors for renal subcapsular hematoma after Ho：YAG laser lithotripter through flexible ureteroscope. Conclusion：Urinary tract infection，hydronephrosis and manual irrigation in the operation are independent risk factors for renal subcapsular hematoma after Ho：YAG laser lithotripter throughflexible ureteroscope.

Abstract:Objective：To demonstrate the feasibility and safety of sutureless retroperitoneoscopic partial nephrectomy with bipolar co－agulation. Methods：From December 2012 to June 2016，523 patients underwent retroperitoneoscopic partial nephrectomy（RPN） at our institution were enrolled. Excluding tumor staging greater than T1a，suture or transperitoneal laparoscopic cases，there were 75 cases of sutureless RPN. Results：The average RENAL score was 4.5；the average age of patients was 53.4 years old； the body mass index was 24.1 kg/m2；the average tumor diameter was 1.9 cm；the average warm ischemia time was 6.9min；the average blood loss was 88.8 mL；blood transfusion was needed in one case；no transit was open；the complication rate was 9.3%；the average time of ischemia was 6.9min；the average postoperative hospital stay was 6.4 days；the mean creatinine was 71.5 mmol/L before operation；the average creatinine was 76.5 mmol/L after operation and the average follow-up time was 32.1 months. Conclusion：Sutureless RPN is a safe and feasible and oncological effective method. Given that it is free from laparoscopic knotting and stitching，it may encourage laparo－scopic novice to learn confidently and master this more difficult procedure.

Abstract:Objective：To assess the predictive value of Guy’s score and S.T.O.N.E. score for success rate and complication rate of percutaneous nephrolithotomy（PCNL）. Methods：The present study is aretrospective study. Patients received PCNL between January 2015 and December 2017 were included in the study and were screened with included and excluded standard. GSS scores and S.T.O.N.E. score were generated based on CT image，and complication after the operation was recorded. Results：Totally 518 cases were included in the present study，and the operation success rate was 87.26%. The GSS score and S.T.O.N.E. score could both pre－dict the success rate of PCNL and residual calculi，and were associated with the length of stay，operationtime and postoperative com－plication. Conclusion：The GSS score and S.T.O.N.E. score could both predict the success rate of PCNL effectively and no significant difference was found between the two scores.

Abstract:Objective：To evaluate the effectiveness of flexible ureteroscopy（F-URS） and laser lithotripsy in the treatment of infectious renal calculi with multi-drug resistant bacteria infection. Methods：The clinical data of 15 patients who were diagnosed as infectious renal calculi with multi-drug resistant bacteria infection and treated by flexible ureteroscopic lithotripsy in our department between 2016 January and 2017 December were retrospectively reviewed. In all patients，ureter stent was placed for 2 weeks before surgery and 2 to 4 week after surgery，preoperative intravenous sensitive antibiotics was used for at least 1 week. One stage or multi-stage surgery was processed in different cases. Patient demographics（age，sex，body mass index），stone characteristics（stone size，location） and pe－rioperative measures（duration of operation，hospitalization and stone free rate（SFR） and complication rates） were reviewed. Results：A total of 15 patients were included in the study and successfully treated by F-URL. The mean stone size was （2.07±0.72） cm. The mean duration of operation was （52.87±18.97） min. The mean length of hospital stay was （3.40±2.06） d. Renal pus substance was observed in 8 patients. Five patients underwent second stage surgery and 2 patients underwent third stage surgery. One stage SFR and the total SFR was 53.3%（8/15） and 80.0%（12/15），respectively. Residual fragments were failed to be cleaned in 3 patients（20.0%） due to inability to reach in result of location in an isolated or enclosed lower calyx. Postoperative complications were ob－served in 4 patients[26.7%；fever（n=2），persistent hematuria（n=1），mild ureter injury（n=1）]. No severe complications or mortality occurred. Conclusion：In spite of challenge in skill and risk of severe complication in treating infectious renal calculi with multi-drug resistant bacteria infection，F-URS can be a safe and effective modality in premise of fully preparation，duration reduction，skilled and staging operation.

Abstract:Objective：To investigate the efficacy and safety of flexible ureteroscopy lithotripsy without preoperative stent placement in the treatment of upper urinary tract calculi. Methods：The clinical data of 269 patients who were scheduled for flexible ureteroscopy lithotripsy without preoperative stent placement from November 2016 to September 2017 in our department were analyzed retrospec－tively. Results：The success rate of operation was 89.6%，while the mean operation time was 40.3 min. The complication rate was 6.2%，and the stone-free rate was 92.5%. Conclusion：Flexible ureteroscopy lithotripsy without preoperative stent placement is safe and effective，and it can decrease the medical cost，so it is worthy to be promoted.

Abstract:Objective：To investigate the risk factors of systemic inflammatory response syndrome（SIRS） after retrograde intrarenal surgery（RIRS） with holmium laser lithotripsy in patients with renal or/and proximal ureteral calculi. Methods：The clinical data of 890 patients who underwent RIRS with holmium laser lithotripsy for renal or/and proximal ureteral calculi were retrospectively ana－lyzed from November 2013 to August 2016. The patients were divided into two groups，and the odds ratio（OR） and the 95% confi－dence interval（95%CI） were calculated by univariate and multivariate logistic regression analysis to determine the risk factors after RIRS. Results：In 890 patients（male 584，female 306），SIRS（37/890） was found in all of the 4.2% patients. In univariate analysis，SIRS was significantly related with the use of immuno－suppressive agents，a recent history of stone ralated fever，pre－operative positive urine culture，preoperative WBCs in urine，and urine pus during operation（P<0.05）. SIRS was not correlated with gender，age，BMI，hypertension，diabetes mellitus before opera－tion，the serum creatinine level，operation time，and stone size（P>0.05）. Multivariate analysis further confirmed that SIRS was signifi－cantly associated with a recent history of stone related fever（P=0.014，OR=4.22，95%CI=1.341 to 13.331），preoperativeurine WBCs increase（≥544/mL）（P<0.001，OR=5.075，95%CI=2.350 to 10.959），intraoperative urine pus（P<0.001，OR=8.373，95%CI=2.773 to 25.279）. Conclusion：A recent history of stone related fever，preoperative WBCs in urine，intraoperative urine pus are risk factors for SIRS after RIRS. The risks should be paid for full attention，controlled and treated before operation，if necessary，surgical staging should be needed.

Abstract:Objective：To discuss the application of enhanced recovery after surgery（ERAS） in the perioperative among the patients with radical cystectomy. Methods：Under the peritoneoscope，115 patients with bladder cancer accepting laparoscopic radical cystec－tomy were divided into the ERAS group and conventionaltreatment group at random. The ERAS scheme was applied in ERAS，while the conventional scheme was applied in the conventional treatment group to observe a series of indexes which include first exhaust，first defecation，intestinal obstruction，hospital stay，etc. Results：The first time of anal exsufflation and the first defecation time in ERAS group were （34.67±3.13） h and （55.10±5.73） h， while the first time of anal exsufflationand the first defecation time in the conventional treatment group were （43.03±4.42） h and （63.64±4.82） h， respectively. The intestinal function recovery of patients in ERAS group was obviously reduced by comparing with the conventional treatment group. First bed-off time in ERAS group was （24.89±5.74） h， which was also less than the conventional treatment group （39.58±7.85） h. The difference had the statistical sig－nificance（P<0.05）. The length of stay in ERAS group was （7.81±2.03） d， which was less than the conventional treatment group （13.56±1.99） d. The difference had the statistical significance（P<0.05）. Conclusions：After radical cystectomy， enhanced recovery aftersurgery is safe and reliable. Moreover， under the precondition of not increasing complications， it can shorten average length of stay and speed up patients’ recovery.

Abstract:Objective：To explore risk factors for the ureteral stones leading to the development of patients with urosepsis as severe sepsis or septic shock. Methods：The clinical data of patients with ureteral calculi associated with urosepsis admitted to our hospital from January 2016 to December 2017 were retrospectively collected. According to the progress of severe sepsis or septic shock，the patients were divided into the case group and the control group. Univariate analysis was performed on the influencing factors of gender，age，body mass index（BMI），diabetes mellitus，history of previous stone surgery，stone site，stone size，degree of hydronephrosis，pe－ripheral white blood cell count，platelet count，serum albumin levels，creatinine，C-reactive protein（CRP），procalcitonin（PCT），urine culture and blood culture，and logistic regression analysis was performed on significant correlation risk factors. Results：Univariate analysis showed that the difference of gender，age，diabetes mellitus，peripheral blood leukocyte count，platelet count，serum creatinine，CRP，PCT were statistically significant（P<0.05）；the difference of BMI，the history of previous stone surgery，stone size，stones site，degree of hydronephrosis，serum albumin，urine culture，blood culture was not statistically significant（P>0.05）. Multivariate analysis showed that the most relevant factors associated with progression of urosepsis to severe sepsis/septic shock were age，peripheral white blood cell count，platelet count，and CRP. Conclusion：Age，peripheral blood leukocyte count，platelet count and CRP are the risk factors for the progression of ureteral calculi-causing sepsis to severe sepsis or septic shock and should be actively managed in these patients.

Abstract:Objective：To evaluate the effect of enhanced recovery after surgery（ERAS） on adrenal and renal tumor operation. Methods：The patients with adrenal tumor or renal tumor treated by the proposed surgery in our hospital from March 2017 to February 2018 were randomly divided into ERAS group and routine group by random number table method. According to preset inclusion and exclusion criteria，89 cases were in ERAS group，including 38 cases of adrenal tumor，15 cases of kidney cancer and 36 cases of renal cyst，100 cases were in the routine group，including 49 cases of adrenal tumor，16 cases of kidney cancer and 35 cases of renal cyst. The ERAS group was treated by preset ERAS measures and was compared with the routine group by perioperative indicators. Results：Compared with those of routine group，postoperation first drinking time[（3.1±1.7） h vs. （7.8±3.5） h，t′= -11.419，P＝0.00０]，postoperation first eating time[（7.6±3.7） h vs. （13.0±6.9） h，t′=-6.611，P＝0.00０] and postoperation first off-bed ambulation time[（9.1±4.9） h vs. （26.9±16.3） h，t′=-10.449，P＝0.00０） in ERAS group were earlier；postopertion placing urinary catheter time[（10.1±4.5） h vs. （23.2±15.4） h，t=-8.165，P＝0.00０]，postoperative anal exhaust time[（10.0±7.6） h vs. （15.0±9.0） h，t′=-4.157，P＝0.00０] and postoperative hospitalization days[（2.7±1.8） d vs. （3.6±2.1） d，t′=－３.128，P=0.002] were significantly shorter in ERAS group；postoperative 2 h VAS pain score[（3.3±0.8） vs. （4.3±0.8），t=-8.925，P＝0.00０] and postoperation first off-bed ambulation VAS pain score[（2.5±0.6） vs. （3.4±0.7），t=-8.662，P＝0.00０] were lower in ERAS group. There was no significantly statistical difference in operation time[（55.8±32.5） min vs. （58.5±31.8） min，t′=-0.557，P=0.578]，bleeding[（48.2±39.2） mL vs. （48.3±34.6） mL，t′=－0.008，P=0.994]，postoperative compli－cations（3/89 vs. 6/100， ?字2=0.712，P=0.398） and drainage tube retention time between two groups[（24.4±16.2） h vs. （27.0±15.3） h，t′=－1.１４３，P=0.255]. Conclusion： The application of the ERAS concept is safe and effective in perioperative period of adrenal and kidney turnor surgery，which can significantly accelerate postoperative rehabilitation，improve patient’s comfort and shorten hospital stay.

Abstract:Objective：To evaluate intrapelvic pressures during laser lithotripsy using different semi-rigid and flexible ureteroscopes. Methods：Intrapelvic pressures was measured on a porcine cadaveric urinary system model with two size of semi-rigid ureteroscopes （Wolf F6/7.5 and Wolf F8/9.8） and two models of flexible ureteroscopes（Polyscope and Olympus URF-P6）. 200 μm Holmium laser fiber was placed into the working cannel previously. The semi-rigid ureteroscopes were placed in distal ureter，middle ureter and ureteropelvic junction and the flexible ureteroscopes were fixed in ureteropelvic junction. Intropelvic pressure was recorded at irriga－tion pressures of 50，100，200，300，400，500 cmH2O. Results：There is a linear correlation between intrapelvic pressures and irrigation pressures. The intrapelvic pressures raised slowly when the semi-rigid ureteroscopes were put at distal ureter. The intrapelvic pres－sures raised at the fastest pace when the semi-rigid ureteroscopes were placed at ureteropelvic junction. The intrapelvic pressures using Wolf F6/7.5 ureteroscope were lower than that using Wolf F8/9.8 ureteroscope at the same irrigation pressure. The intrapelvic pres－sures of semi-rigid were higher than those of the flexible ones when ureteroscopes were placed at ureteropelvic junction. According to the equation of linear regression，the value of irrigation pressures was estimated when the intrapelvic pressure reaching 40 cmH2O，and it is found that a low irrigation pressure（34.950 to 44.284 cmH2O） could rise the intrapelvic pressures to 40 cmH2O when the se－mi-rigid ureteroscopes being put at the middle and upper ureter. The safe irrigation pressure was higher（205.345 to 313.659 cmH2O） when the semi-rigid ureteroscopes being placed at the distal ureter. The flexible ureteroscopes could withstand the maximum irrigation pressure keeping the intrapelvic pressures within the safe range，and the safe irrigation pressure of Olympus URF-P6（400.457 cmH2O） was higher than Polyscope（238.419 cmH2O）. Conclusion：In order to maintain the intrapelvic pressures at a low level，thin－ner semi-rigid ureteroscope should be used in the treatment of middle and distal ureteral calculi，and flexible rather than semi-rigid ureteroscope should be used to handle proximal ureteral calculi.

Abstract:Objective：To evaluate the safety and efficiency of ureteroscopic vision method applying in establishing channel during percutaneous nephrolithotomy（PCNL）. Methods：A retrospective study had been done including totally 325 percutaneous nephrolitho-tomy operations from January 2014 to June 2017 in the First Affiliated Hospital of Chongqing Medical University. All channels of PCNL were established under the guidance of ultrasound，of which 169 cases were operated using the ureteroscopic vision method to establish PCNL channel，while the other 156 cases did not. The sex，age，BMI，prior surgery and the S.T.O.N.E nephrolithometry score were compared before the operation between two groups. And channel establishment time，channel primary success rate，operation time，the amount of bleeding，and the channel related complication were compared between two groups. Results：The patients in both groups were successfully implemented PCNL. There were statistically significant differences in channel primary success rate，channel establi-shment time，and the amount of bleeding during operation between two groups（100% vs. 94.9%，（10.5±2.4） min vs. （16.4±2.6） min，（11.15±5.99） g/L vs. （17.05±9.42） g/L；P<0.05）. Complications related to channel establishment，including loss of channel，excessive puncture，vascular damage，massive hemorrhage，calyx neck injury were compared between two groups；those in experimental group was significantly lower than those in control group. The post-operation complications were classified and compared，according to Clavien-Dindo system，the complications above grade Ⅲ were statistically significant lower in experimental group than in control group. Conclusion：The safety and efficiency of percutaneous nephrolithotomy can make improvement with ureteroscopic vision method.

Abstract:Objective：To compare the efficiency and safety of two kinds of stone baskets using in flexible ureteroscopy. Methods：Totally 75 patients with renal stones who underwent flexible ureteroscopy were randomly divided into two groups，and were treated by the same team of surgeons. For patients in group A，the stone fragment was catched out with Escape nitinol stone retrieval basket（Boston Scientific Corporation，USA，Catalog NO. M0063902010），and for patients in group B，the stone fragment was catched out with Ncircle nitinol tipless stone extractor（Cook Incorporated，USA，Catalog NO. NTSE-022115-UDH）. The clinical data such as basketing efficiency，operation time，stone free rate and complications were compared between two groups. Results：The average bas－keting time was 27 minutes in patients of group A，and 35 minutes in patients of group B. The average best basketing frequency in one minute was 7.70 in patients of group A，and 3.87 in patients of group B. The stone free rate one month after operation was 89.19% in patients of group A，and 68.42% in patients of group B. All these three clinical data of group A was superior to that of group B，and the difference had statistical meaning. The average operation time was 68 minutes in patients of group A，and 71 min－utes in patients of group B. The complication rate was 5.41% in patients of group A，and 5.26% in patients of group B. There was no statistical difference in these two clinical data. No damage occurred no matter in the collecting system of patients or in the ureter－scopes due to stone baskets. Conclusion：Both stone baskets are safe for flexible ureteroscopy. A suitable stone basket would improve the basketing efficiency and stone free rate of flexible ureteroscopy.

Abstract:Objective：To explore the application of stentless laparascopic pyeloplasty in children with ureteropelvic junction obstruc－tion（UPJO）. Methods：Clinical data of 45 UPJO children underwent stentless laparascopic pyeloplasty from July 2015 to June 2016 were collected and matched with D-J tube drainage. The relevant clinical data were analyzed. Results：All operations were completed successfully without converting to open surgery. The postoperative hospital stay was shorter in stentless group than in D-J group [（8.64±3.18） d vs. （9.05±1.28） d，t=-0.789，P=0.434]；the mean operation time was shorter in stentless group than in D-J group [（98.39±18.02） min vs. （106.93±25.77） min，t=-1.81，P=0.077]，and no significant differences was observed. The postoperative uri－nary tract infection rate was lower in stentless group（3/45） than in D-J group（4/45） without significant differences（?字2=0.155，P=0.500）. Postoperative hematuria rate was higher in stentless group（5/45） than in D-J group（4/45） without significant differences （?字2=0.123，P=0.500）. The postoperative urinary extravasation rate was higher in stentless goup（13/45） than in D-J group（1/45） with significant differences（?字2=12.18，P=0.000）. Long-time follow-up showed all children were asymptomatic and hydronephrosis was relieved in varying degrees. Conclusion：Stentless laparas－copic pyeloplasty is feasible in the treatment of UPJO in chil－dren.

Abstract:Objective：To compare the efficacy of the percutaneous nephrolithotomy（PCNL） in the treatment of upper urinary calculi in different accesses. Methods：Totally 1438 cases underwent PCNL from October 2009 to June 2017 were reviewed retrospectively. The cases were divided into staghorn calculi group，multiple stones group，single renal calculi group（combined or not combined with ureteral calculi） and ureteral calculi group. The efficacy of PCNL in different accesses was compared in the aspects of the first period calculus complete clearance rate，operation time and intraoperative and postoperative complications. Results：For the staghorn calculi group，there were significant differences in the first period calculus complete clearance rate and the operation time（P<0.05） between upper accesses and middle/lower accesses. For the multiple stones group，there were significant differences in the first period calculus complete clearance rate and the operation time. For the single renal calculi group（combined or not combined with ureteral calculi） ，there was no significant difference in the first period calculus complete clearance rate，but there were significant differences in the operation time. For the ureteral calculi group，there was no significant difference in the first period calculus complete clearance rate and the operation time（P >0.05）. The puncture success rate was 100% to all the cases. Conclusion：The first period calculus com－plete clearance rate is higher and the operation time is shorter for staghorn calculi and multiple stones through upper pole access. So we suggest to treat the staghorn calculi and multiple stones through upper pole access.

Abstract:Objective：To evaluate the possible predictors of proximal ureteral stone disintegration by shock wave lithotripsy（SWL）. Methods：This retrospective study included 79 patients（61 males，18 females； mean age：43.5 years） who were performed non-en－hanced multi-detector computed tomography（MDCT） before SWL. The possible predictors such as gender，age，stone location，stone length，stone cross-sectional diameter，stone volume，body mass index（BMI），skin-to-stone distance（SSD），and stone density （Hounsfield unit，HU） were analyzed. Results：The stone length（P=0.038），cross-sectional diameter（P=0.001） and stone density（P=0.001） were significant different based on univariate analysis. By the multiple liner regression analysis，the stone density（RR=3.31，P=0.048） and cross-sectional diameter（RR=7.953，P=0.003） were considered to be the independent predictors of SWL success. Conclusion：Instead of stone length，the cross-sectional diameter and stone density were the independent predictors of SWL success.

Abstract:Objective：To evaluate the value of preoperative risk score（PRS） for the choice of urinary diversion surgery of bladder cancer patients. Methods：The PRS and comprehensive complication index（CCI） of 303 bladder cancer patients who had undergone urinary diversion surgery（continent ileal reservoir-kock pouch，ileal conduit，cutaneous ureterostomy） from January 2012 to may 2017 in the First Affiliated Hospital of Chongqing Medical University were collected. The relationship between PRS and CCI in the same or different surgeries were analyzed，then the optimized PRS value to lessen the complications of the surgery was chosen，and quantitative evi－dence for the choice of urinary diversion surgery was provided. Results：PRS differed in three urinary diversion surgeries（the average PRS of cutaneous ureterostomy was 0.72±0.23，the average PRS of ileal conduit was 0.48±0.24，and the average PRS of continent ileal reservoir-kock pouch was 0.34±0.17，no statistical differences was observed in CCI between the three surgery（the average CCI of cutaneous ureterostomy was 38.19±16.34，the average CCI of ileal conduit was 36.04±11.17，and the average CCI of continent ileal reservoir-kock pouch was 38.14±13.36. According to the normal distribution principal，when taking the left 80% confidence interval，the postoperative complication out the interval was more serious than that in the interval. The value of left 80% confidence interval PRS was between 0.34 and 0.86 in cutaneous ureterostomy group，the average CCI which out the interval was obviously higher than that inside the interval，and significant differences were captured（P<0.01）. The value of left 80% confidence interval PRS was between 0.15 and 0.60 in ileal conduit group，the av－erage CCI which out the interval was obviously higher than that inside the interval，and significant differences were captured（P<0.01）. The value of left 80% confidence interval PRS was be－tween 0.14 and 0.42 in continent ileal reservoir-kock pouch group，the average CCI which out the interval was obviously higher than that inside the interval，and significant differences were cap－tured（P<0.05）. Conclusion：Continent ileal reservoir-kock pouch is not advised when PRS is beyond 0.42，ileal conduit is not ad－vised when PRS is beyond 0.60，cutaneous ureterostomy is not advised when PRS is beyond 0.86.

Abstract:Objective：In order to explore the potential risk factors for urosepsis following endourological treatment of upper urinary stones. Surgical methods include percutaneous nephrolithotomy（PCNL），rigid ureteroscopic lithotripsy，flexible ureteroscopic lithotripsy. Methods：Totally 2 032 patients treated with PCNL，1 781 patients treated with rigid ureteroscopic lithotripsy and 625 patients treated with flexible ureteroscopic lithotripsy were collected from January 2013 to January 2017. Association between different groups was as－sessed by Chi squar to find out the related factors. Then multivariate logistic regression analysis on these related factors was used to further analysis. Results：Multivariate logistic regression analysis showed that urine routine examination（OR95%CI=2.008 to 7.584），urine culture examination（OR95%CI=1.496 to 3.489），stone size（OR95%CI=1.811 to 5.420） were related with urinary sepsis follow－ing PCNL. Urine routine examination（OR95%CI=1.602 to 6.776），urine culture examination（OR95%CI=2.659 to 7.924） were related with urinary sepsis following rigid ureteroscopic lithotripsy. Urine culture examination（OR95%CI=1.739 to 12.770） was related with urosepsis following flexible ureteroscopic lithotripsy. Conlusion：Preoperative urinary tract infection is the most important factor for urosepsis following endourological management of upper urinary stones. In addition，stone size is also one of the important factors for urosepsis after PCNL.

Abstract:Department of Urology，The First Affiliated Hospital of Chongqing Medical University

Abstract:Objective：To collect and organize the clinical data of the patients who were diagnosed ascastration resistant prostate cancer（CRPC）and were treated by abiraterone in our hospital’s urology center，and to analyze the clinical data including the response rate，drug adverse event，early survival time，and the follow-up treatment. Methods：The clinical data of 55 CRPC patients who were treated with abiraterone from October 2015 to October 2017 were analyzed，including the treatment of the serum PSA，the serum testosterone level，the follow-up to the body bone imaging and other imaging studies. Results：Following data analysis，in accordance with PSA workgroup（PSAWG） standard，55 patients had a PSA overall relief rate of 56.4%，lower than that of 68% based on the international multicenter randomized double blind controlled trials，cp-aa-302.For 31 patients with a marked PSA relief，the serum PSA had been decreased by more than 50%，some patients even had decreased to more than 90%，and clinical symptoms were significantly im－proved. According to the baseline，PSA baseline value can be divided into different levels：PSA<20 ng/mL，20 to 80 ng/mL，>80 ng/mL，and the PSA response rates were 63.6%，59.1%，55.6%. The Gleason scores were divided into <8，8 and >8，with the PSA remission rate of 30.7%，58.1% and 81.8%. The difference of effective endocrine therapy time can be divided into <18 months，18 to 36 months，>36 months，and its PSA remission rateswere63.2%，52% and 54.5%. In addition，at the early stage of the early use of abiraterone，the occurrence of PSA Flare in 15 patients（15/51，27.2%）in the urosurgical treatment center in our hospital was observed and recorded. The patients were divide into ease and not alleviate group. The method of statistical Kaplan Meier-survival analysis was used and it is concluded that the use of combined therapy with prednisone and abiraterone acetatehad obvious benefit（17.06 monthsvs. 11.68 months）. Conclusion：Most of the CRPC patients who have been treated with abiraterone have benefited from it；the clinical symptoms and quality of life are improved. In addition to the Gleason rating，patients with different baseline values are expected to have an uncorrelated therapeutic effect and obvious benefit can be achieved for CRPC patient treated with the combination of the abiraterone. It has been found that the PSA Flare will pro－duce a more positive response to the response of the tumor to the drug，affecting the level of PSA relief. The occurrence of adverse events should also be closely monitored to assist in the treatment.

Abstract:Objective：To analyze the efficacy and safety of flexible ureteroscopy with holmium laser（FURS） without a pre-existing ureteral stent for renal calculi. Methods：Clinical data of 716 patients who underwent FURS from July 2017 to December 2017 at this hospital were analyzed retrospectively. There were 377 patients without pre-existing ureteral stent and 339 patients with pre-existing ureteral stent. The overall the success rate of ureteral access sheath placement，operation time，overall hospital stay，stone free rate （SFR） and overall complication rate were compared between the two groups. Results：There was no significant difference between two groups in the preoperative stone size，stone location and SFR（94.1% vs. 93.7%）（P>0.05）. But there were significant differences be－tween two groups in the success rate of ureteral access sheath placement（90.2% vs.100.0%）（P<0.05）. No serious complication occurred in two groups. Conclusion：It is safe and effective for the FURS without pre-existing ureteral stent. Compared with the pre-existing group，there was no significant difference in the results. The success rate of FURS without pre-existing ureteral stent depends on the success of the sheath implantation and is related to the stricture or distortion of ureter，as well as the surgeon’s experience.

Abstract:Objective：To explore the correlation between operation time and renal function deterioration of flexible ureteroscope in treating renal stones in a solitary kidney postoperatively. Methods：From January 2013 to December 2016，patients with renal stones in a solitary kidney were treated with fURS and followed up for one year in our hospital. Patients whose serum creatinine had elevated obviously were taken as control group and the other patients were as study group. Operation time and serum creatinine one month and one year after operation were recorded. Other parameter including age，gender，body mass index，stone size，number of procedures，stone free rate，hydronephrosis，hypertension and diabetes were analyzed. Results：A total of 42 patients were included in the retrospec－tive study：33 patients were in the study group and 9 patients were in the control group. There was no statisticallydifference in factors such as age，gender，body mass index，number of procedures，stone free rate，hydronephrosis，hypertension and diabetes had（P>0.05）. Other factors such as stone size，operation time and postoperative infection-related complication were higher in the control groupthan in the study group（P<0.05）. Preoperative serum creatininehad no statisticallydifference between the two groups（P>0.05）. But postop－erative serum creatinine in the control group one month and one year after operation were higher than that in the study group（P<0.05）. The area under the receiver operating characteristic curve of operation time in predicting the deterioration of renal function was 0.78 and the cutoff point was 56minutes（95%CI=0.617 to 0.950），in which the sensitivity and specificity were respectively 81.8% and 66.7%. Conclusion：Flexible ureteroscope was a safe treatment method for renal stones in solitary kidney at one year follow-up. But operation time should be controlled within 56minutes. Otherwise，kidney function will be damaged irreversibly and eventually lead to the deterioration of renal function.

Abstract:Objective：To investigate the clinical presentation and the pathological pattern of renal biopsy patients as well as their re－lations. Methods：The clinical and pathological data collected from the patients（≥14 years of age） with renal biopsy from January 2008 to December 2016 in the First Affiliated Hospital of Chongqing Medical University and analyzed the pathological patterns ac－cording to gender，age and clinical presentation. Results：Patients of 1773 were recruited in this study，with male and female ratio of 1∶1.13 and average age was （43.24±13.78） years old. ①Primary glomerulonephritis（PGN），secondary glomerulonephritis（SGN），tubulo-interstitial nephropathy（TIN） and hereditary glomeruler diseases（HGD） were accounted for 77.8%，20.8%，1.3% and 0.1%，respectively. The proportion of PGN was higher than other pathological patterns in young，middle-aged and elder groups，but the con－stitute ratio of PGN and SGN in three groups had no statistical significance（P=0.069）. ②IgA nephropathy（IgAN，41.1%） was the most common PGD，followed by mesangial proliferative glomerulonephritis（MsPGN，22.5%） and membranous nephropathy（MN，14.6%）. The top 3 pathological patterns of SGD were 1upus nephritis（LN，36.4%），Henoch-schonlein purpura nephritis（HSPN，20.1%） and HBV-associated glomerulonephritis（HBV-GN，18.5%）. The constitute ratio of PGN’s all pathological patterns had sta－tistically significant differences in the three aged groups（P=0.000）. IgAN was the most common pathological pattern in the young group and the middle-aged group，while MN was the most common pathological pattern in the old group. ③Nephrotic syndrome（40.3%） and chronic glomerulonephritis（34.2%） were the main clinical presentations in PGN. The most common pathological patterns of nephrotic syndrome and chronic glomerulonephritis were MN and IgAN，respectively. ④The constitute ratio of SGN’s all pathological patterns had statistically significant difference in gender（P=0.000）. The proportion of LN in woman was higher than that in man. The proportion of HSPN，HBV-GN and diabetic nephropathy（DN） in man was higher than that in woman. ⑤The most common pathological grading of LN and HSPN was Ⅳand ⅢB，respectively，and the most common pathological pattern of HBV-GN was MsPGN. Conclusion：The pathological pattern of nephropathy has some relations with age，gender and clinical presentation，but don’t form a regular correspondence. Therefore，nephropathy patients should not just limit to clinical diagnosis，but also should finish renal biopsy to make pathological pattern and pathological grading clearly，which can guide treatment and improve prognosis.

Abstract: