Dorsal oral mucosa graft urethroplasty for female urethral stricture reconstruction: A narrative review.

Female urethral stricture is currently a challenging situation. In general, urethra dilatation can be selected for treatment, but the complications and high recurrence rate urge doctors to consider other treatments. Recently, dorsal oral mucosa graft urethroplasty is concerned by more and more surgeons, but there are not enough reports so far. A comprehensive search of dorsal oral mucosa graft urethroplasty was performed. According to the existing literature, there are applications of buccal mucosa and lingual mucosa, and compared with other kinds of grafts, the success rate is higher. However, there is a lack of multicenter, large sample and long follow-up studies. And there is still no enough comparative study between different types of oral mucosa. In summary, dorsal oral mucosa graft urethroplasty is an effective option for the management of female urethral stricture. More multicenter and large sample studies with long-term follow-up data are needed.

CT Three-Dimensional Visualization Model in Diagnosis and Treatment of Stress Urinary Incontinence: A Retrospective Study.

OBJECTIVE: To study the clinical effect of stress urinary incontinence sling surgery based on CT 3-dimensional visualization model, and to explore the value of three-dimensional visualization model in the diagnosis and treatment of stress urinary incontinence. METHODS: Patients with stress urinary incontinence in our center from October 2020 to March 2022 were studied retrospectively. Among them, 16 cases received preoperative 3-dimensional visualization model construction, 18 cases did not use preoperative 3-dimensional model construction. The perioperative results, the postoperative results and the correlation between some related parameters of 3-dimensional visualization model and the severity of stress urinary incontinence were analyzed. RESULTS: Compared with traditional surgery, the operation time of 3D group is significantly shorter (P < 0.05). There was no significant difference in intraoperative blood loss, perioperative fever, bleeding, micturition, pudendal or inguinal pain and postoperative symptom improvement. The posterior vesicourethral angle measured by 3-dimensional reconstruction model was correlated with ICI-Q-SF score. CONCLUSIONS: The construction of three-dimensional visualization model of stress urinary incontinence can be used in clinic as a safe and effective new preoperative evaluation technique, and more potential applications can be further explored.

Case Report: Metastatic Signet-Ring-Cell Carcinoma of the Bladder From Breast Invasive Lobular Carcinoma Detected by Computed Tomography.

Secondary bladder tumors are relatively rare among all bladder tumors, while bladder metastases from breast cancer have been rarely reported. Furthermore, signet-ring differentiation may appear in the metastases from a breast invasive lobular carcinoma regardless of whether the primary breast tumor had signet-ring cells, which may cause diagnostic uncertainty. We report a case of a 55-year-old female patient with diffuse bladder thickening as the chief complaint and no specific clinical manifestations. While the cystoscopy showed multiple scattered red protuberances, the biopsy suggested signet-ring-cell carcinoma. The gastroscopy results suggested poorly differentiated adenocarcinoma with signet-ring cells. Considering the patient's history of invasive lobular carcinoma of the breast, chronic myeloid leukemia, and metastatic endometrial carcinoma from the breast, we performed an immunohistochemical analysis and the results indicated that signet-ring-cell carcinomas of the stomach and bladder originated from the invasive lobular carcinoma of the breast. We performed positron emission tomography/computed tomography and the results showed that there were multiple bone metastases already present. This was the first English case report of invasive lobular carcinoma of the breast metastasizing to the uterus, stomach, bladder, and bones with multiple signet-ring-cell variations. This study shares our reasons for misdiagnosing and opinions on diagnosing and treating for this kind of cases.

Comprehensive analysis of necroptosis-related long noncoding RNA to predict prognosis, immune status, and immunotherapeutic response in clear cell renal cell carcinoma.

Background: Necroptosis has been found to be associated with tumorigenesis and tumor progression. However, the prognostic effect of long noncoding RNAs (lncRNAs) associated with necroptosis in clear cell renal cell carcinoma (ccRCC) is still unclear. Methods: Pearson correlation analysis was used to identify necroptosis-related genes and lncRNAs obtained from The Cancer Genome Atlas Kidney Renal Clear Cell Carcinoma (TCGA-KIRC) dataset. Least absolute shrinkage and selection operator (LASSO) regression and Cox regression analyses were used to identify a novel necroptosis-associated lncRNAs signature that significantly correlated with survival of ccRCC. Next, single sample gene set enrichment analysis (ssGSEA) was employed to assess the extent of infiltration with immune cells. Analyses to predict the half-maximal inhibitory concentration (IC50) of patients in different risk groups were also conducted. Moreover, follow-up data of an immunotherapy cohort were used to test for differences in the immunotherapeutic efficiency between two risk groups. Finally, patients with ccRCC were divided into two groups based on 6 prognostic lncRNAs. Results: We developed a signature of necroptosis-related lncRNAs, which was verified as an independent prognostic factor that can predict prognosis up to 7 years. Patients with higher risk scores were shown to have higher immune suppressive cell infiltration levels and expression of immune checkpoint genes, which suggests that these patients were in a state of immunosuppression. Patients in the low-risk group were found to have an increased response to immunotherapy. A prognostic prediction nomogram was conducted to predict long-term survival of patients. Cluster A tumors were considered hot tumors, since they were correlated with higher levels of immune infiltration and were more sensitive to immunotherapy. Conclusions: A comprehensive bioinformatics analysis was conducted, which found that the necroptosis-associated lncRNA signature might be a potent prognostic factor for patients with ccRCC, which could contribute to improved prognosis of these patients.

An immune cell infiltration-related gene signature predicts prognosis for bladder cancer.

To explore novel therapeutic targets, develop a gene signature and construct a prognostic nomogram of bladder cancer (BCa). Transcriptome data and clinical traits of BCa were downloaded from UCSC Xena database and Gene Expression Omnibus (GEO) database. We then used the method of Single sample Gene Set Enrichment analysis (ssGSEA) to calculate the infiltration abundances of 24 immune cells in eligible BCa samples. By weighted correlation network analysis (WGCNA), we identified turquoise module with strong and significant association with the infiltration abundance of immune cells which were associated with overall survival of BCa patients. Subsequently, we developed an immune cell infiltration-related gene signature based on the module genes (MGs) and immune-related genes (IRGs) from the Immunology Database and Analysis Portal (ImmPort). Then, we tested the prognostic power and performance of the signature in both discovery and external validation datasets. A nomogram integrated with signature and clinical features were ultimately constructed and tested. Five prognostic immune cell infiltration-related module genes (PIRMGs), namely FPR1, CIITA, KLRC1, TNFRSF6B, and WFIKKN1, were identified and used for gene signature development. And the signature showed independent and stable prognosis predictive power. Ultimately, a nomogram consisting of signature, age and tumor stage was constructed, and it showed good and stable predictive ability on prognosis. Our prognostic signature and nomogram provided prognostic indicators and potential immunotherapeutic targets for BCa. Further researches are needed to verify the clinical effectiveness of this nomogram and these biomarkers.

Identification of a Four Hypoxia-Associated Long Non-Coding RNA Signature and Establishment of a Nomogram Predicting Prognosis of Clear Cell Renal Cell Carcinoma.

To identify novel hypoxia-associated long non-coding RNAs (lncRNAs) as potential biomarkers, we developed a risk stratification signature and constructed a prognosis prediction nomogram of clear cell renal cell carcinoma (ccRCC). Hypoxia-related lncRNAs were identified through Pearson correlation analysis between the expression profiles of hypoxia-related differentially expressed genes and lncRNAs from The Cancer Genome Atlas Kidney Renal Clear Cell Carcinoma (TCGA-KIRC) dataset. Then, a signature of four key lncRNAs (COMETT, EMX2OS, AC026462.3, and HAGLR) was developed. The four lncRNAs were downregulated in high-grade, advanced stage, and high-risk ccRCC. The signature had an independent and long-standing prognosis prediction ability up to a 10-year follow-up. Notably, the risk score was significantly positively correlated with the infiltration abundances of six immune cells from the Tumor IMmune Estimation Resource (TIMER). The gene set enrichment analysis (GSEA) also suggested that the signature was involved in metabolism and tumorigenesis, which were closely related to the hypoxic tumor microenvironment. Ultimately, a nomogram of signature, age, stage, and grade, was built to predict the individual long-term survival possibility. Finally, the expressions of four lncRNAs were validated by quantitative real-time PCR (qRT-PCR). Our study identified a four-lncRNA signature and established a prognostic nomogram that reliably predicts survival in ccRCC. The findings may be beneficial to therapeutic customization and medical decision-making.

Minimally Invasive Surgeries in the Management of Renal Parapelvic Cysts: A Retrospective Comparative Study.

PURPOSE: To compare the efficiency and safety of two minimally invasive surgeries, laparoscopy and flexible ureteroscopy (fURS), in the management of renal parapelvic cysts. MATERIALS AND METHODS: Between January 2013 and April 2019, patients who suffered from parapelvic cysts and received fURS or laparoscopy at our hospital were recruited for this study. All patients underwent biopsies of the cyst wall. Primary outcome was treatment success, which was defined as symptomatic and radiological. During follow-up, telephone contact and CT scans were used to record any relevant symptoms and any recurrence, respectively. RESULTS: A total of 33 patients (22 in fURS; 11 in laparoscopy) were included in this study. Flank pain prior to the procedures were reported by 14/22 patients and 6/11 in fURS and laparoscopy, respectively (P = .62), and patients had complete pain relief after the operation. The complication rate was significantly lower in the fURS group than in the laparoscopy group (P = .01). Minor complications were observed in 3/22 and 5/11 patients (Grade 1 and 2) in the fURS and laparoscopy group, respectively. All patients were controlled by conservative treatment. However, 1/11 major complication (Grade 3b) was detected in the laparoscopy group and managed by ureteroscopy to remove the obstruction under general anesthesia. Significant differences were found in operative time (P = .01) and postoperative hospital stay (P = .01), while medical expenses were similar between the two groups (P = .42). During follow-up, no recurrence was detected in CT scans. CONCLUSION: In the management of parapelvic cysts, two minimally invasive surgeries were comparable in efficiency. However, fURS was superior to laparoscopic unroofing with regard to the complication rate, operative time, and postoperative hospital stay.

The feasibility of one-stage flexible ureteroscopy lithotripsy in solitary kidney patients with 1-3 cm renal stones and risk factors of renal function changes.

PURPOSE: To compare perioperative outcomes and long-term renal function changes between prior stenting (PS) and not prior stenting (NPS) before flexible ureteroscopy lithotripsy (f-URS) for solitary kidney patients. METHODS: Solitary kidney patients with 10-30 mm renal stones were enrolled in this historical control study. Perioperative parameters and complications were compared. Stone-free was defined as the absence of any residual stones on a CT scan. Renal function changes were evaluated by estimated glomerular filtration rate (eGFR) and adjusted for body surface area. A decrease in the eGFR over 20% was identified as 'deterioration' in renal function. The follow-up period was at least 6 months. Logistic regression was used to identify risk factors of renal function deterioration. RESULTS: Of the 76 patients included, 40 cases experienced prior stenting before f-URS. The average stone diameter was 16.8 ± 4.7 mm, ranging from 10.0 to 28.4 mm. Initial SFR was 85.0 and 83.3% in the PS and NPS groups, respectively (p = 0.842), while SFR after the second procedure was 97.5 and 94.4% (p = 0.926). Seven PS and 5 NPS patients developed complications (p = 0.666). At the postoperative 6 months, seven patients showed a deteriorated renal function. Surgical time in minutes was identified as a risk factor for renal function deterioration after the operation (OR = 1.061, 95% CI: 1.015-1.109, p = 0.009, per minute). CONCLUSION: It appears that one-stage f-URS without PS could be feasible for 10-30 mm renal stones in solitary kidney patients, and less surgical time might be beneficial to protect renal function.

lncRNAHIF1A-AS2 Promotes Renal Carcinoma Cell Proliferation and Migration via miR-130a-5p/ERBB2 Pathway.

BACKGROUND: Long non-coding RNAs (lncRNAs) are essential for tumorigenesis and progression of diverse cancers. This study aims to investigate the roles of lncRNAs on renal carcinoma. METHODS: The expression of lncRNA HIF1A-AS2 in clear cell renal cell carcinoma (ccRCC) and adjacent non-cancer tissues was identified by quantitative real-time PCR (qRT-PCR). Investigations were performed on biological function of lncRNA HIF1A-AS2 on cell proliferation, cell cycle, apoptosis and invasion of ccRCC by overexpression and knockdown experiments. Further, luciferase reporter assay and Western blot were constructed to explore molecular mechanisms underlying the function of lncRNA HIF1A-AS2. RESULTS: HIF1A-AS2 was highly expressed in kidney cancer tissues and ccRCC cells. Interference of HIF1A-AS2 in vivo hindered cell proliferation, invasion and migration while accelerated cell apoptosis. Overexpression of HIF1A-AS2 presented an opposite effect that repressed the expression of miR-130a-5p, and miR-130a-5p inhibited the expression of HIF1A-AS2. Additionally, rescue experiments exhibited that oncogenic function of HIF1A-AS2 was partially dependent on the suppression of miR-130a-5p. CONCLUSION: Our results indicated a critical role for the HIF1A-AS2-miR-130a-5p axis in renal carcinoma progression, which may act as a promising diagnostic biomarker and a pivotal therapeutic target for renal carcinoma cures.

Three-gene prognostic biomarkers for seminoma identified by weighted gene co-expression network analysis.

Testicular germ cell tumors (TGCTs) are common in young males, and seminoma accounts for a large proportion of TGCTs. However, there are limited records on the exploration of novel biomarkers for seminoma. Hence, we aimed to identify new biomarkers associated with overall survival in seminoma. mRNA-seq and clinical traits of TGCTs were downloaded from UCSC XENA and analyzed by weighted gene co-expression network analysis. After intersection with differentially expressed genes in GSE8607, common genes were subjected to protein-protein interaction (PPI) network construction and enrichment analyses. Then, the top 10 common genes were investigated by Kaplan-Meier (KM) survival analyses and univariate Cox regression analyses. Ultimately, TYROBP, CD68, and ITGAM were considered three prognostic biomarkers in seminoma. Based on correlation analysis between these genes and immune infiltrates, we suggest that the three biomarkers influence the survival of seminoma patients, possibly through regulating the infiltration of immune cells. In conclusion, our study demonstrated that TYROBP, CD68, and ITGAM could be regarded as prognostic biomarkers and therapeutic targets for seminoma patients.

Comparison of the Safety and Efficacy between Transperitoneal and Retroperitoneal Approach of Laparoscopic Ureterolithotomy for the Treatment of Large (>10mm) and Proximal Ureteral Stones: A Systematic Review and Meta-analysis.

PURPOSE: We aimed to compare the safety and efficacy between laparoscopic transperitoneal ureterolithotomy (LTU) and laparoscopic retroperitoneal ureterolithotomy (LRU) in the treatment of large (>10mm) and proximal ureteral stones. MATERIALS AND METHODS: Electronic databases, including PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus were searched through December 2019. Comparative studies comparing the two approaches were included. The primary outcome was a single-procedure success rate; the secondary outcomes included operative time, hospital duration, and complications (according to the Clavien-Dindo Grade). Newcastle-Ottawa scale (NOS) and the modified Jadad scale were used to evaluate the quality of the included studies. The Egger's test estimated publication bias. The meta-analysis was performed by Review Manager 5.3 and STATA 15.0. RESULTS: Seven studies, involving 125 participants in LTU group and 128 in LRU group, were included in the study. The results suggested that both single-procedure success rate and the rate of postoperative paralytic ileus were significantly higher in the LTU group than in the LRU group (95.2% vs 87.5%, 95% CI: .00-.16, RD = .08, P = .04; 10.4% vs 0, 95% CI: .02- .19, RD = .10, P = .02, respectively). No publication bias of the primary outcome was observed with the Egger's test (P = .117). No significant differences were noted in terms of operative time and hospital duration (95% CI: -18.95-8.80, MD = -5.08, P = .47; 95% CI: -.98- .58, MD = -.20, P = .61, respectively). Additionally, according to Clavien-Dindo Grade, the rates of major complications (>= Grade 3a) including open conversion (.8% vs 5.5%, 95%CI: -.11- .01, RD = -.05, P = .12), stone migration (8.1% vs 6.7%, 95% CI: -.08- .11, RD = .02, P = .76), vascular injury (5.4% vs 0, 95%CI: -.03- .14, RD = .05, P = .21) and ureteral stricture (1.3% vs 5.3%, 95% CI: -.11- .02, RD = -.04, P = .20), were comparable between the two groups. CONCLUSION: In the treatment of large and proximal ureteral calculi, LTU has a significantly higher single-procedure success rate and a higher rate of postoperative paralytic ileus than LRU. However, the complication was well-tolerated. The small sample size and limited, including studies, were the main limitations.