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Robotic-assisted Laparoscopic Nephrectomy with Vein Thrombectomy:Initial Experience and Outcomes from a Single Surgeon

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Current Medical Science 2018年第5期38卷 834-839页

作者： Xin-wen KE Xing ZENG Xian WEI Yuan-qing SHEN Jia-hua GAN Ji-hua TIAN Zhi-quan HU Department of urology Tongji HospitalTongji Medical CollegeHuazhong University of Science and TechnologyWuha430030China Department of urology the Central Hospital of WuhanWuhan 430014China

This study was designed to explore the safety and feasibility of robotic-assisted laparoscopic nephrectomy with vein thrombectomy (RAL-NVT) for the treatment of renal cell carcinoma (RCC)with venous tumor thrombus (VTT).Clinical data of 6 patients treated with RAL-NVT between July 2016 and November 2017 in our hospital were retrospectively collected and *** were 5 males and 1 female with their age ranging from 48 years to 68 *** renal tumors were right-sided and one left-sided. Three cases fell in level 0 VTT,one in level I and two in level Ⅱ.preoperative imaging revealed lymph node involvement in 1 case and distant metastasis in 2 *** RCC with level 0 VTT,the renal vein of the affected side was adequately and carefully dissected around the thrombus to the proximity of inferior vena cava (IVC)and was ligated with Hem-o-loks without cross-clamping the *** level Ⅰ and Ⅱ VTT,the IVC was cross-clamped cephalically and caudally around the tumor thrombus and all tributaries were sequentially blocked to ensure the safe retrieval of *** operations were successfully completed without conversion to open *** mean operative time was 150(115-230)***-clamping of the IVC happened in 3 cases,and the blocking time was 14, 19 and 20min,*** mean estimated blood loss during the operation was 400 (200-580)*** peritoneal drainage tube was removed 5 to 9 days after the operation, and all patients were postoperatively discharged at 6 to 11 *** pathological analysis confirmed that the RCCs were comprised of 4 clear cell RCCs,1 papillary cell RCC,and 1 medullary cell RCC;2 cases were Fuhrman grade Ⅱ,3 cases grade Ⅲ,and 1 case undefined *** recurrence or progression was observed during the follow-up of 4.2(3-6)*** concluded that RAL-NVT is highly challenging but safe and feasible for the treatment of RCC with VTT.

关键词： robotics laparoscopy renal cell carcinoma venous tumor thrombus thrombectomy

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Epidemiologic methods for investigating male fecundity

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Asian Journal of Andrology 2014年第1期16卷 17-22页

作者： Jrn Olsen Cecilia Host Ramlau-Hansen Department of Public Health Section for Epidemiology Aarhus University Aarhus Denmark

Fertility is a couple concept that has been measured since the beginning of demography, and male fecundity （his biological capacity to reproduce） is a component of the fertility rate. Unfortunately, we have no way of measuring the male component directly, although several indirect markers can be used. Population registers can be used to monitor the proportion of childless couples, couples who receive donor semen, trends in dizygotic twinning, and infertility diagnoses. Studies using time-to-pregnancy （TTP） may identify couple subfecundity, and TTP data will correlate with sperm quality and quantity as well as sexual activity and a number of other conditions. Having exposure data available for couples with a fecund female partner would make TTP studies of interest in identifying exposures that may affect male fecundity. Biological indicators such as sperm quality and quantity isolate the male component of fertility, and semen data therefore remain an important source of information for research. Unfortunately, often over half of those invited to provide a sperm sample will refuse, and the study is then subject to a selection that may introduce bias. Because the most important time windows for exposures that impair semen production could be early fetal life, puberty, and the time of ejaculation; longitudinal data over decades of time are required. The ongoing monitoring of semen quality and quantity should continue, and surveys monitoring fertility and waiting TTP should also be designed.

关键词： data collection epidemiology epidemiological monitoring fertility sperm count time-to-pregnancy (TTP)

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Karyotypic analysis of intersexuality in Chinese from Taiyuan

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Asian Journal of Andrology 2000年第2期2卷 155-157页

作者： Zhen-Guo MI Xiao-Feng YANG Tao LAN Department of urology, First Affiliated Hospital, Shanxi Medical University, Taiyuan 030001, China Department of urology First Affiliated Hospital Shanxi Medical University Taiyuan China

Aim: To analyze the kayrotypic patterns of 33 cases of intersexuality in Chinese from Taiyuan, China in order tofurther clarify its mechanism of development and the interrelationship between karyotype and phenotypic sex. Meth-ods: High-resolution GTG-banding chromosome technique was used to analyze the karyotype patterns. Results:In these patients, 57.58% were male pseudohermaphrodites (46, XY), 18.18%, female pseudohermaphrodites (46,XX), 12.12%, true hemaphrodites, and 12.12%, other karyotypes, Although testes can be seen in 88.8% of kary-otypes with Y chromosome, 73.68% of the patients were of female social sex. In 42.82% of patients the social sex isin conformity with their karyotypes. There were 2 cases of male pseudohennaphrodites, where the sex chromosome wasnormal, but abnormalities were found in chromosomes 9, 13, or 14. Conclusion: Sex chromosomes determine thedirection of gonadal and sex differentiation, while the development of the normal gonad and extemal genitalia shouldhave the participation of many autosomal chromosomes as well.

关键词： pseudobermaphroditism hermaphroditism karyotyping gene chromosome

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Robot-assisted laparoscopic pyeloureterostomy for ureteropelvic junction rupture sustained in a traffic accident:A case report

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World Journal of Clinical Cases 2020年第22期8卷 5802-5808页

作者： Si Hyun Kim Woong Bin Kim Jae Heon Kim Sang Wook Lee Department of urology Soonchunhyang University Cheonan HospitalCheonan 31151South Korea Department of urology Soonchunhyang University Bucheon HospitalBucheon 14584South Korea Department of urology Soonchunhyang University Seoul HospitalSoonchunhyang University Medical CollegeSeoul 04401South Korea Department of urology Soonchunhyang University Bucheon HospitalSoonchunhyang University School of MedicineBucheon 14584South Korea

BACKGROUND Ureteral reconstruction is a highly technical type of laparoscopic or open *** incidence of ureteral injury is low;however,ureteral injuries tend to be *** surgery for urinary reconstructive surgery is growing in popularity,which has made procedures such as pyeloplasty,ureteroureterostomy,and ureteroneocystostomy possible,with minimal damage to the *** the best of our knowledge,this is the first report of robot-assisted laparoscopic pyeloureterostomy in Korea,in a 17-year-old female patient with a ureteral *** SUMMARY The patient,a 17-year-old girl without previous medical history,was presented at the emergency room and complained of abdominal and back *** in the right upper quadrant was observed on physical *** in the right perirenal space was observed without abdominal organ injuries on the initial enhanced abdomen computed tomography(CT)*** injury was not suspected at this *** patient was stabilized via conservative treatment,but complained of right flank pain 3 wk later and revisited the emergency *** enhanced abdominal CT scan revealed a huge urinoma in the right perirenal space with hydronephrosis of the right *** and antegrade pyelography were *** and discontinuity of the ureter were found.A rupture of the ureteropelvic junction was diagnosed and reconstructive surgery was *** 3 mo,the patient did not complain of any symptoms without any abnormal radiologic *** This case report discusses the safety and effectiveness of this minimal invasive procedure as an alternative to conventional open or laparoscopic surgery.

关键词： Robot surgical procedure Ureteral injuries Minimal invasive surgical procedures Reconstructive surgical procedures urology Case report

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Long-term survival of a patient with a large adrenal primitive neuroectodermal tumor: A case report

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World Journal of Clinical Cases 2019年第3期7卷 340-346页

作者： Jun Dai Hong-Chao He Xin Huang Fu-Kang Sun Yu Zhu Dan-Feng Xu Department of urology Ruijin Hospital Shanghai Jiaotong University School of Medicine

BACKGROUND Adrenal primitive neuroectodermal tumor(PNET) is an extremely rare malignant tumor with poor prognosis and of neural crest origin. Herein, we report a case of adrenal PNET and summarized its clinical and pathological characteristics on the basis of 16 patients reported *** SUMMARY A female patient aged 25 years presented with right lumbago for 12 mo, and preoperative computed tomography showed a huge right adrenal mass. She received tumorectomy, and post-operative pathological examination showed adrenal PNET. After surgery, she underwent adjuvant chemotherapy and was followed up 31 mo after surgery. She received brachytherapy for right paracolic and hepatic metastases. She was alive and followed up for 60 mo. In available studies, only 57.14%(4/7) and 44.44%(4/9) were positive for the expression of neuron-specific enolase and synaptophysin, respectively, although CD99 expression was found in all the patients(100%; 10/10).CONCLUSION It is concluded that adrenal PNET is very rare and highly malignant, and histology is a golden standard in its diagnosis. Surgery and adjuvant therapy is the main treatment.

关键词： Primitive neuroectodermal tumor Adrenal gland Case report

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Robotic laparoendoscopic single-site surgery(R-LESS) ：current status in urology

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第二军医大学学报 2011年第10期32卷 1050-1055页

作者： Riccardo Autorino YANG Bo Jihad H. Kaouk section of Laparoscopic and Robotic Surgery Glickman Urological and Kidney Institute Cleveland Clinic 9500 EuclidAvenue Q10 44195-Cleveland Ohio USA Department of urology Changhai Hospital Second Military Medical University Shanghai 200433 China

Laparoendoscopic single-site surgery(LESS)is technically challenging;it can reduces instrument triangulation and robust retraction and is associated with a steep learning *** instruments of the daVinci  surgical system(Intuitive Surgical)are designed with seven degrees of motion mimicing the dexterity of the human hand and *** inherent feature of the robotic arm provides superior ergonomics when performing LESS,especially for complex reconstructive *** review analyzes the evidence supporting current and future application of robotic technology in the field of urologic LESS.

关键词：摘要编辑部编辑工作读者

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Current strategies to diagnose and manage positive surgical margins and local recurrence after partial nephrectomy

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Asian Journal of urology 2022年第3期9卷 227-242页

作者： Umberto Carbonara Daniele Amparore Cosimo Gentile Riccardo Bertolo Selcuk Erdem Alexandre Ingels Michele Marchioni Constantijn H.J.Muselaers Onder Kara Laura Marandino Nicola Pavan Eduard Roussel Angela Pecoraro Fabio Crocerossa Giuseppe Torre Riccardo Campi Pasquale Ditonno European Association of urology(EAU) Young Academic Urologists(YAU)Renal Cancer Working Group Department of Emergency and Organ Transplantation-urology Andrology and Kidney Transplantation UnitUniversity of BariBariItaly Division of urology Department of OncologySchool of MedicineSan Luigi HospitalUniversity of TurinOrbassanoTurinItaly Department of urology San Carlo Di Nancy HospitalRomeItaly Division of Urologic Oncology Department of UrologyIstanbul University Istanbul Faculty of MedicineIstanbulTurkey Department of urology University Hospital Henri MondorAPHPCreteilFrance Department of urology SS Annunziata Hospital"G.D’Annunzio"University of ChietiChietiItaly Department of urology Radboud University Medical CenterNijmegenthe Netherlands Department of urology Kocaeli University School of MedicineKocaeliTurkey Department of Medical Oncology IRCCS Ospedale San RaffaeleVita-Salute San Raffaele UniversityMilanItaly urology Clinic Department of MedicalSurgical and Health ScienceUniversity of TriesteTriesteItaly Department of urology University Hospitals LeuvenLeuvenBelgium Department of urology Magna Graecia University of CatanzaroCatanzaroItaly Unit of Urological Robotic Surgery and Renal Transplantation University of FlorenceCareggi HospitalFlorenceItaly

Objective:No standard strategy for diagnosis and management of positive surgical margin(PSM)and local recurrence after partial nephrectomy(PN)are reported in *** review aims to provide an overview of the current strategies and further perspectives on this patient ***:A non-systematic review of the literature was *** research included the most updated articles(about the last 10 years).Results:Techniques for diagnosing PSMs during PN include intraoperative frozen section,imprinting cytology,and other specific *** clear evidence is reported about these *** PSM management,active surveillance with a combination of imaging and laboratory evaluation is the first option line followed by *** local recurrence management,surgery is the primary curative approach when possible but it may be technically difficult due to anatomy resultant from previous *** this scenario,thermal ablation(TA)may have the potential to circumvent these limitations representing a less invasive *** surgery represents a valid option;six studies analyzed the outcomes of nephrectomy on local recurrence after PN with three of these focused on robotic ***all,complication rates of salvage surgery are higher compared to TA but ablation presents a higher recurrence rate up to 25%of cases that can often be managed with repeat ***:Controversy still exists surrounding the best strategy for management and diagnosis of patients with PSMs or local recurrence after *** surveillance is likely to be the optimal first-line management option for most patients with *** and salvage surgery both represent valid options in patients with local recurrence after ***,salvage PN and radical nephrectomy have fewer recurrences but are associated with a higher complication rate compared to *** this scenario,robotic surgery plays an important role in improving salvage PN and radical nephrectom

关键词： Positive surgical margin Local recurrence Partial nephrectomy Radical nephrectomy Robot-assisted partial nephrectomy

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Transrectal ultrasonography in infertile patients with persistently elevated bacteriospermia

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Asian Journal of Andrology 2008年第5期10卷 731-740页

作者： Sandro La Vignera Aldo E. Calogero Alessandro Arancio Roberto Castiglione Gaetano De Grande Enzo Vicari section of Endocrinology Andrology and Internal Medicine Department of Biomedical Sciences University of Catania 95123 Catania Italy urology Unit Ospedale Umberto L 96100 Syracuse ltaly

Aim： To identify and define prostate and seminal vesicle abnormalities in patients with chronic male accessory gland infection （MAGI） who failed to respond to antibacterial treatment. Methods： We selected 67 consecutive patients with MAGI and persistently elevated bacteriospermia （≥ 10^6 colony forming units [CFU]/mL） after three antibiotic courses. Fourteen infertile patients with initial chronic microbial （≥ 10^6 CFU/mL） MAGI who responded to antibacterial treatment （〈 10^3 CFU/mL） served as a control group. All patients and controls underwent transrectal ultrasonography （TRUS） scans and semen analysis. Patients with low seminal plasma volume （〈 1.5 mL） underwent both preejaculatory and post-ejaculatory TRUS examination. Results： TRUS revealed multiple abnormalities indicative of：（i） bilaterally extended prostato-vesiculitis （group A： 52 cases, 77.6%）（nine of these patients also had micro-emphysematous prostate abscess）; and （ii） prostato-vesiculitis with unilateral or bilateral sub-obstruction of the ejaculatory ducts （group B： 15 cases, 22.4%）. Mean sperm concentration, total sperm number, ejaculate volume and pH value were significantly higher in group A than in group B. In addition, sperm forward motility and the percentage of normal forms were significantly worse than in controls, whereas leukocyte concentration was significantly higher in group A. Group B patients had all sperm parameters, but their pH values, significantly different from those of controls. Conclusion： Although antibiotic therapy is considered suitable when microbial MAGI is suspected, it is impossible to account for a poor response to antibiotics merely on the basis of conventional criteria （clinical history, physical and ejaculate signs）. Thus, TRUS may be helpful in the follow-up of these patients.

关键词： persistent bacteriospermia prostato-vesiculitis sub-obstruction of the ejaculatory ducts micro-emphysematous prostate abscess sperm parameters ultrasound features

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Long-term results of extended Boari flap technique for management of complete ureteral avulsion:A case report

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World Journal of Clinical Cases 2022年第34期10卷 12610-12616页

作者： Ming-Zhu Zhong Wei-Na Huang Gui-Xiao Huang En-Pu Zhang Lu Gan Department of urology Shenzhen Baoan Shiyan People's HospitalShenzhen 518108Guangdong ProvinceChina Department of urology The Third Affiliated Hospital of Shenzhen UniversityShenzhen 518005Guangdong ProvinceChina

BACKGROUND Ureteroscopy is well-established as a primary treatment modality for *** avulsion,particularly complete or full-length avulsion with a resultant long segment of the ureter left attached to the ureteroscope,is a rare but devastating complication of the *** of this complication is ***,general consensus regarding the optimal management is *** report our experience of managing a complete ureteral avulsion case via an extended Boari flap technique with long-term *** SUMMARY A 41-year-old female patient subjected to complete ureteral avulsion caused by ureteroscopy was referred to our hospital.A modified,extended Boari flap technique was successfully performed to repair the full-length ureteral *** mobilization of the bladder and affected kidney followed by psoas hitch and downward nephropexy maximized the probability of a tension-free *** blood supply preservation to the flap also contributed to the *** the 4-year study period,no complications except for a mild urinary frequency and a slightly lower maximum urinary flow rate were *** patient was satisfied with the surgical *** The extended Boari flap procedure is a feasible and preferred technique to manage complete ureteral avulsion,particularly in emergencies.

关键词： Ureteral avulsion Ureteroscopy Complication Reconstruction Boari flap Case report

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Treatment of Erectile Dysfunction:Today and Tomorrow

Treatment of Erectile Dysfunction:Today and Tomorrow

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中华医学会第五次全国男科学学术会议

作者： Ronald W.Lewis Professor and Chairman Section of UrologyMedical College of GeorgiaAugustaGA 30912USA

The management of erectile dysfunction has changed much over the last 25 - 30 years. Approximately 30 years ago most men who suffered from erectile dysfunction were thought to have a primary psychological disorder and were referred to psychiatrists or psychologists who dealt with sexual problems. Today it can be clearly said that we are in the era of oral therapy for the treatment of erectile dysfunction in the western world due to the very successful introduction of very effective oral therapy which was first released in 1998, in the form of sildenafil or Viagra . Subsequently, within the last several years two new oral agents of the same class of drug, phos-

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