Diagnostic performance of machine learning in systemic infection following percutaneous nephrolithotomy and identification of associated risk factors.

Objective: This study aims to investigate the predictive performance of machine learning in predicting the occurrence of systemic inflammatory response syndrome (SIRS) and urosepsis after percutaneous nephrolithotomy (PCNL). Methods: A retrospective analysis was conducted on patients who underwent PCNL treatment between January 2016 and July 2022. Machine learning techniques were employed to establish and select the best predictive model for postoperative systemic infection. The feasibility of using relevant risk factors as predictive markers was explored through interpretability with Machine Learning. Results: A total of 1067 PCNL patients were included in this study, with 111 (10.4 %) patients developing SIRS and 49 (4.5 %) patients developing urosepsis. In the validation set, the risk model based on the GBM protocol demonstrated a predictive power of 0.871 for SIRS and 0.854 for urosepsis. Preoperative and postoperative platelet changes were identified as the most significant predictors. Both thrombocytopenia and thrombocytosis were found to be risk factors for SIRS or urosepsis after PCNL. Furthermore, it was observed that when the change in platelet count before and after PCNL surgery exceeded 30*109/L (whether an increase or decrease), the risk of developing SIRS or urosepsis significantly increased. Conclusion: Machine learning can be effectively utilized for predicting the occurrence of SIRS or urosepsis after PCNL. The changes in platelet count before and after PCNL surgery serve as important predictors.

Bladder metastasis from type 2 papillary renal cell carcinoma: A case report.

Renal cell carcinoma (RCC) is a common urinary tumor that may be pathologically divided into different subtypes: clear cell RCC, papillary RCC (PRCC) and chromophobe RCC. The most common organs of RCC metastasis are the lung, liver and bones, while bladder metastasis is rare. The treatment for PRCC metastasis is also a problem due to limited clinical data. Therefore, every single case of PRCC metastasis may significantly contribute to establishing a standard treatment protocol. The present study reported on a patient who suffered from repetitive bladder PRCC metastasis with 1.5 years of follow-up. A 54-year-old male patient was diagnosed with left renal pelvic carcinoma in March 2020 and underwent a laparoscopic radical nephroureterectomy of the left kidney. The postoperative histological examination revealed that the tumor was consistent with a type 2 PRCC. Bladder metastasis was discovered three months after the surgery and transurethral resection of the bladder tumor (TURBT) was performed to eliminate the tumor in the bladder. Only three months after the initial TURBT, bladder metastasis was detected again, combined with lung metastasis. The patient refused to undergo radical cystectomy. Therefore, a second TURBT was arranged and targeted drugs were administered. However, both bladder and lung metastases were insensitive to the treatment strategy applied, although immunotherapy was subsequently added. The patient died in October 2021 due to respiratory failure and cachexia. The report aims to provide the whole treatment progress and lessons learned from this case, which is relatively rare.

Primary retroperitoneal mucinous cystic tumour of borderline malignancy mimicking kidney duplicate: cases report and literature review.

BACKGROUND: Primary retroperitoneal mucinous cystic tumours with borderline malignancy (PRMC-BM) are rare and difficult to diagnose preoperatively. We are the first to report two cases of PRMC-BM which mimic a duplex kidney and evaluate the outcomes of different surgical procedures. CASE PRESENTATION: We describe two cases of retroperitoneal cystic tumours. Both were diagnosed with duplex kidney with hydronephrosis on computed tomography scan. The first patient underwent robot-assisted laparoscopic surgery and was found to have a retroperitoneal cystic tumour. The other patient underwent an ultrasound-guided puncture before surgery and was diagnosed with retroperitoneal lymphangioma. Retroperitoneal cystectomy was performed using an open transperitoneal procedure. The final pathologic diagnosis in both cases implies PRMC-BM. The open surgical approach was associated with a shorter operation time, less intraoperative blood loss, and protected cyst wall integrity by comparing the different surgical approaches. During follow-up, the patient in the first case had tumour recurrence six months post-surgery, and the other patient was healthy without recurrence or metastasis 12 months post-surgery. CONCLUSIONS: Primary retroperitoneal mucinous cystic tumours with borderline malignancy can be enclosed within the kidney and misdiagnosed as other cystic diseases of the urinary system. Thus, an open surgical approach may be more suitable for this type of tumour.

Successful robot-assisted partial nephrectomy for giant renal hilum angiomyolipoma through the retroperitoneal approach: A case report.

BACKGROUND: Giant renal angiomyolipomas (AMLs) may lead to complications including flank pain, hematuria, hypertension, retroperitoneal hemorrhage and even death. Giant AMLs which grow around renal hilar vessels and the ureter are rare. Most previous reports on the treatment of giant renal AMLs have focused on open surgery or a transperitoneal approach, with few studies on the retroperitoneal approach for large AMLs. We here report a case of giant renal hilum AML successfully treated with robot-assisted laparoscopic nephron sparing surgery the retroperitoneal approach, with a one-year follow-up. CASE SUMMARY: A 34-year-old female patient was diagnosed with renal AML 11 years ago and showed no discomfort. The tumor gradually increased in size to a giant AML over the years, which measured 63 mm × 47 mm ×90 mm and was wrapped around the right hilum. Therefore, a robotic laparoscopic partial nephrectomy (LPN) via the retroperitoneal approach was performed. The patient had no serious postoperative complications and was discharged soon after the operation. At the one-year follow-up, the patient's right kidney had recovered well. CONCLUSION: Despite insufficient operating space via the retroperitoneal approach, LPN for giant central renal AMLs can be completed using a well-designed procedure with the assistance of a robotic system.

Application of nanotechnology in the diagnosis and treatment of bladder cancer.

Bladder cancer (BC) is a common malignancy in the genitourinary system and the current theranostic approaches are unsatisfactory. Sensitivity and specificity of current diagnosis methods are not ideal and high recurrence and progression rates after initial treatment indicate the urgent need for management improvements in clinic. Nanotechnology has been proposed as an effective method to improve theranosis efficiency for both non-muscle invasive bladder cancer (NMIBC) and muscle invasive bladder cancer (MIBC). For example, gold nanoparticles (AuNPs) have been developed for simple, fast and sensitive urinary sample test for bladder cancer diagnosis. Nanoparticles targeting bladder cancers can facilitate to distinguish the normal and abnormal bladder tissues during cystoscopy and thus help with the complete removal of malignant lesions. Both intravenous and intravesical agents can be modified by nanotechnology for targeted delivery, high anti-tumor efficiency and excellent tolerability, exhibiting encouraging potential in bladder cancer treatment. Photosensitizers and biological agents can also be delivered by nanotechnology, intermediating phototherapy and targeted therapy. The management of bladder cancer remained almost unchanged for decades with unsatisfactory effect. However, it is likely to change with the fast-developed nanotechnology. Herein we summarized the current utility of nanotechnology in bladder cancer diagnosis and treatment, providing insights for the future designing and discovering novel nanoparticles for bladder cancer management.

New-Onset Diabetes After Renal Transplantation (NODAT): Is It a Risk Factor for Renal Cell Carcinoma or Renal Failure?

BACKGROUND Diabetes mellitus (DM) is a risk factor for renal failure and possibly for renal cell carcinoma (RCC). Post-transplantation DM occurs frequently after solid organ transplantation. We investigated whether new-onset diabetes after renal transplantation (NODAT) is a risk factor for RCC or renal failure. MATERIAL AND METHODS Data of 96,699 discharged patients with and without NODAT were extracted from the 2005-2014 Nationwide Inpatient Sample (NIS) database, after excluding patients with DM diagnosed at least 1 year prior to renal transplantation. Main outcomes were RCC diagnosis less than 1-year post-transplantation, RCC stage, and renal failure. Univariate and multivariate regression analyses were performed to identify demographic and clinical factors associated with post-transplantation RCC or renal failure. RESULTS Significant differences were found in age and race between patients with and without NODAT (both P<0.001). The renal failure rate was 0.8% (n=1) in NODAT patients and 0.3% (n=314) in those without NODAT. Older age (OR, 1.030; 95% CI: 1.023 to 1.036), male (OR, 1.872; 95% CI: 1.409 to 2.486), Black (OR, 2.199; 95% CI: 1.574 to 3.071) and hospitalization in urban teaching hospitals were associated with increased risk of RCC. CONCLUSIONS Analysis of over 90,000 NIS hospitalizations with diagnosis-coded kidney transplantation suggested that NODAT may not be an independent risk factor for RCC and renal failure.

LIMK2 acts as an oncogene in bladder cancer and its functional SNP in the microRNA-135a binding site affects bladder cancer risk.

LIM kinases modulate multiple aspects of cancer development, including cell proliferation and survival. As the mechanisms of LIMK-associated tumorigenesis are still unclear, we analyzed the tumorigenic functions of LIM kinase 2 (LIMK2) in human bladder cancer (BC) and explored whether the newly identified LIMK2 3´-UTR SNP rs2073859 (G-to-A allele) is correlated with clinical features. Expression levels of LIMK2 in 38 human BC tissues and eight cell lines were examined using quantitative real-time PCR and immunohistochemistry. LIMK2 was overexpressed in most BC tissues (27/38, 71%) and BC-derived cell lines (6/8), and was more frequently overexpessed in high-grade than low-grade BC (80% vs. 47%). The effects of LIMK2 on BC cell proliferation, survival and migration, were studied by overexpression and RNA interference approaches in vitro and in vivo. LIMK2 overexpression promoted proliferation, migration and invasion of BC cells, while LIMK2 depletion inhibited cell invasion and viability and induced growth arrest in vitro and in vivo. PCR-Restriction Fragment Length Polymorphism (RFLP) was used to genotype LIMK2 SNP rs2073859 and multivariate logistic regression applied to assess the relationship between allele frequency and clinical features in 139 BC patients. Functional analyses localized SNP rs2073859 within the microRNA-135a seed-binding region and revealed significantly lower LIMK2 G allele expression. The frequency of A genotypes (AG + AA) was higher in the BC group than normal controls and correlated with risks of high-grade and high-stage BC. In conclusion, LIMK2 may function as an oncogene in human BC, while allele-specific regulation by microRNA-135a may influence disease risk.

Decreased expression of VPS33B correlates with disease progression and unfavorable prognosis in renal cell carcinoma.

The aim of this study was to examine correlation between low cytoplasmic expression of VPS33B and clinicopathologic features of renal cell carcinoma (RCC). In this study, ninety RCC patients ranging from years 2006 to 2012 were reviewed. VPS33B expression in tumor tissues and adjacent normal tissues was examined using immunohistochemistry (IHC) and association of VPS33B expression with RCC patient clinicopathologic parameters was evaluated. Final staining scores of 0-5 and 6-7 were respectively considered to be low and high expression. Immunohistochemical analysis confirmed that VPS33B protein expression was predominantly localized in cytoplasm of both RCC and adjacent normal tissues. Lower cytoplasmic VPS33B expression was observed in RCC compared to normal cells (P = 0.007). In addition, cytoplasmic VPS33B protein levels in tumor tissues were correlated with T stage (T1 vs. T2 vs. T3) (P = 0.038), stage (I-II vs. III-IV) (P = 0.035), and renal vein invasion (P = 0.039) of RCC patients. Lower RCC cytoplasmic VPS33B expression had a significantly shorter disease free survival (DFS) compared to the higher expression group (P = 0.030). Multivariate analysis suggested that low cytoplasmic VPS33B expression was an independent predictor for DFS of RCC patients. (P = 0.030). Our results suggest that low cytoplasmic VPS33B expression is a potential unfavorable prognostic factor for progression and prognosis of RCC.

Highly stable selenadiazole derivatives induce bladder cancer cell apoptosis and inhibit cell migration and invasion through the activation of ROS-mediated signaling pathways.

Bladder cancer is still a common malignancy of the urinary tract due to the high metastasis rate and unexpected side effects of drug treatments. The acidic environment of the urinary bladder also strongly limits the efficacy of the chemotherapeutic agents during the treatment of bladder cancer. In this study, a series of selenadiazole derivatives (SeDs) have been rationally designed and synthesized and could actively suppress the progression and metastasis of bladder cancer cells. SeDs demonstrated better antiproliferative activity and higher stability under different physiological conditions, especially in an acidic urocystic environment, than mitomycin, a clinically used anti-bladder cancer drug. In particular, compound 1b displayed better selectivity between cancer and normal cells in comparison with other compounds. Studies on the structure-activity relationship revealed that the introduction of strong electron donating substituents, such as the methoxy group, resulted in a dramatic enhancement in the anticancer efficacy. Furthermore, 1b induced anti-migration and anti-invasion activities against bladder cancer cells. Mechanistic investigation revealed that compound 1b was able to enter the cells through endocytosis and then trigger reactive oxygen species (ROS) overproduction, further causing DNA damage-mediated p53 phosphorylation and promoting cancer cell apoptosis by regulating the AKT and MAPKs signaling pathways. Altogether, the study provides a strategy for rational design of selenadiazole derivatives with improved stability to antagonize bladder cancer.

XB130 is overexpressed in prostate cancer and involved in cell growth and invasion.

XB130 is a cytosolic adaptor protein involved in various physiological processes and oncogenesis of certain malignancies, but its role in the development of prostate cancer remains unclear. In current study, we examined XB130 expression in prostate cancer tissues and found that XB130 expression was remarkably increased in prostate cancer tissues and significantly correlated with increased prostate specific antigen (PSA), free PSA (f-PSA), prostatic acid phosphatase (PAP) and T classification. Patients with highly expressed XB130 had significantly decreased survival, which suggested XB130 as a possible prognostic indicator for prostate cancer. In vitro experiments showed that reduced XB130 expression restrained tumor growth both in vitro and in vivo. Furthermore, XB130 knockdown hindered transition of G1 to S phase in prostate cancer cell line DU145 and LNCap, which might contribute to the inhibition of cellular proliferation. Results from transwell assay demonstrated that downregulation of XB130 may attenuate invasion and metastasis of prostate cancer. Semiquantitative analysis of Western blot suggested that decreased XB130 expression was accompanied by diminished Akt signaling and EMT process. Thus, above observations suggest that XB130 may be a novel molecular marker and potent therapeutic target for prostate cancer.

Apoptosis of human prostate cancer cells induced by marine actinomycin X2 through the mTOR pathway compounded by MiRNA144.

The present study aimed to determine whether actinomycin X2 (AX2) intercepted the mTOR/PTEN/PI3K/Akt signaling pathway to inhibit human prostate cancer cells (PC-3) in vitro. The effects of AX2 on mTOR, PTEN, PI3K, and Akt at the protein level and mRNA were determined by western blotting and real-time reverse transcription-PCR (RT-PCR), respectively. Concurrently, the effects of AX2 on expression levels of MiRNA144 and MiRNA126 in PC-3 were measured by real-time RT-PCR. The association of MiRNA144 with 3'-UTR of mTOR was identified using the Dual-Luciferase Reporter Gene System. The direct effect of MIRNA144 on the mTOR/PTEN/PI3K/Akt pathway was determined by real-time RT-PCR and western blotting. Apoptosis of PC-3 cells induced by AX2 was determined by MTT and flow cytometry. The results indicated that mTOR/PTEN/PI3K/Akt were decreased and PTEN was increased by AX (1, 10 µmol/l) at protein and mRNA levels in a dose-dependent manner. MiRNA144 was decreased, whereas MiRNA126 was increased by AX2. MiRNA144 associated with 3'-UTR of mTOR was corroborated. Overexpression of MiRNA144 decreased mTOR, but did not affect PTEN, PI3K, or Akt. The proliferation rates of AX2 on PC-3 cells were decreased. It suggests that AX2 induces apoptosis of PC-3 cells via meddling in the mTOR/PTEN/PI3K/Akt signaling pathway, but those effects are compounded by MiRNA144. Both AX2 and MiRNA144 intercept the signaling in different ways but cross on mTOR.

An integrin-targeting nanosystem as a carrier of the selenadiazole derivative to induce ROS-mediated apoptosis in bladder cancer cells, from rational design to action mechanisms.

The development of novel therapeutics for patients with bladder cancer is an important area of research, particularly considering the rather limited treatment options currently available. In this study, we designed and synthesized a conjugate of cancer-targeting selenadiazole derivative BSeC (benzo[1,2,5]selenadiazole-5-carboxylic acid) and the RGD (arginine-glycine-aspartate) peptide, which was used as a targeting molecule, using a PEI polymer as a linker. The results showed that BSeC-PEI-RGD formed core-shell spherical nanoparticles with improved stability in physiological and low pH solutions. The cancer-targeting design significantly enhanced cellular uptake of BSeC-PEI-RGD and decreased its cytotoxicity to normal cells. The nanoparticles could inhibit the migration and invasion of EJ and T24 bladder cancer cell and reduce cancer cell proliferation through the induction of reactive oxygen species (ROS)-dependent apoptosis and mitochondrial dysfunction. Further mechanistic studies using western blotting showed that BSeC-PEI-RGD triggered bladder cancer cell apoptosis by activating p38, JNK and p53 and by inactivating AKT and ERK. In summary, this study demonstrates the rational design of a polymer-based cancer-targeting nanosystem as a carrier of the selenadiazole derivative to treat bladder cancer.

Are the Aging Male's Symptoms (AMS) scale and the Androgen Deficiency in the Aging Male (ADAM) questionnaire suitable for the screening of late-onset hypogonadism in aging Chinese men?

The Aging Male's Symptoms (AMS) scale and the Androgen Deficiency in the Aging Male (ADAM) questionnaire have been widely used for screening men suspected of late-onset hypogonadism (LOH). We evaluated the consistency of the two questionnaires with sex hormone levels. A total of 985 men completed the two questionnaires, as well as an analysis of the serum levels of total testosterone (TT), bioavailable testosterone (BT), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), prolactin (PRL) and sex hormone-binding globulin (SHBG). No correlation was observed between any hormone level and the psychological or somatic section of the AMS score, whereas the sexual section was correlated with the levels of FT, LH, FSH, SHBG and BT. Significant correlations were observed between the result of the two questionnaires and these hormone levels. When LOH was defined as TT < 300 ng/dl and FT < 5 ng/dl, the sensitivity and specificity of the AMS scale were 54.0% and 41.2% compared with 78.7% and 14.8% for the ADAM questionnaire. Several sex hormone levels correlated with the two questionnaires, but neither of these questionnaires had sufficient sensitivity and specificity. It is necessary to provide a new questionnaire applicable to the Chinese population to screening LOH.

miRNA-100 inhibits human bladder urothelial carcinogenesis by directly targeting mTOR.

miRNAs are involved in cancer development and progression, acting as tumor suppressors or oncogenes. In this study, miRNA profiling was conducted on 10 paired bladder cancer tissues using 20 GeneChip miRNA Array, and 10 differentially expressed miRNAs were identified in bladder cancer and adjacent noncancerous tissues of any disease stage/grade. After being validated on expanded cohort of 67 paired bladder cancer tissues and 10 human bladder cancer cell lines by quantitative real-time PCR (qRT-PCR), it was found that miR-100 was downregulated most significantly in cancer tissues. Ectopic restoration of miR-100 expression in bladder cancer cells suppressed cell proliferation and motility, induced cell-cycle arrest in vitro, and inhibited tumorigenesis in vivo both in subcutaneous and in intravesical passage. Bioinformatic analysis showed that the mTOR gene was a direct target of miR-100. siRNA-mediated mTOR knockdown phenocopied the effect of miR-100 in bladder cancer cell lines. In addition, the cancerous metastatic nude mouse model established on the basis of primary bladder cancer cell lines suggested that miR-100/mTOR regulated cell motility and was associated with tumor metastasis. Both mTOR and p70S6K (downstream messenger) presented higher expression levels in distant metastatic foci such as in liver and kidney metastases than in primary tumor. Taken together, miR-100 may act as a tumor suppressor in bladder cancer, and reintroduction of this mature miRNA into tumor tissue may prove to be a therapeutic strategy by reducing the expression of target genes.

Relationship between serum sex hormones levels and degree of benign prostate hyperplasia in Chinese aging men.

Benign prostatic hyperplasia (BPH) is one of the most common medical conditions in middle aged and older men. This study investigated the relationship between serum levels of sex hormones and measures of BPH in the aging male population of China. Prostate symptoms were assessed as part of a free health screening program for men ≥ 40 years of age. The examination included digital rectal examination, determination of serum prostate-specific antigen levels, International Prostate Symptom Score (IPSS) and transrectal ultrasonography. Serum levels of total testosterone (TT), sex hormone binding globulin (SHBG), free testosterone (FT), luteinizing hormone (LH), follicle-stimulating hormone (FSH), prolactin (PRL) and estradiol (E(2)) were evaluated. The men also completed a health and demographics questionnaire and received a detailed physical examination. The final study population consisted of 949 men with a mean age of 58.9 years. Pearson correlation analysis indicated that there were significant correlations between age and levels of all sex hormones except TT, and between age and prostate volume (PV; r=0.243; P<0.01) or IPSS (r=0.263; P<0.01). Additional significant correlations were found between IPSS and serum levels of LH (r=0.112; P<0.01) and FSH (r=0.074; P<0.05), but there were no significant correlations between sex hormone levels and PV. Multivariate linear regression analysis showed significant correlations between age and body mass index (BMI) with PV (P<0.0001). In addition, there was a significant correlation between age and PV with IPSS (P<0.0001). Serum sex hormone levels did not correlate with PV or IPSS. The effects of endocrine changes on measures of BPH in aging men require further investigation in longitudinal and multicenter studies that include patients with all severities of BPH.

A specialized course of basic skills training for single-port laparoscopic surgery.

BACKGROUND: Single-port laparoscopy (SPL) requires specialized skills; however, there are currently no specialized training courses for SPL. The aim of this study is to present an effective specialized training course of basic skills for SPL. METHODS: We designed a specialized training course for single-port laparoscopic basic skills. The study included 10 male urology residents. The trainees practiced the traditional training course for laparoscopy basic skills for 5 days. Basic skills were assessed on day 6 and a self-efficacy confidence index was measured. On day 7, all trainees performed a traditional laparoscopic nephrectomy and single-port laparoscopic nephrectomy. The participants were then randomized into 2 groups: 5 trainees performed the specialized training course and the other 5 trainees continued to practice the traditional training course. Both groups were trained for 5 days. After completion, the trainees were tested on completing a porcine single-port laparoscopic nephrectomy. Operative performance was measured by 2 experts who were blinded to which training the student had received, using an altered global rating. In addition, participants completed a general self-efficacy instrument after performing surgeries. RESULTS: The overall operative performance score for single-port laparoscopic surgery was significantly better in the specialized training group. A significant difference in confidence index was seen between the traditional laparoscopy training and specialized single-port training groups (18.40 ± 2.70 vs 29.4 ± 3.51, respectively; P = .001.). Four relative instrument locations which avoided the problem of crowding were also noted in the specialized training group. CONCLUSION: The specialized training course is effective for developing SPL skills.

Utility of a modality combining FISH and cytology in upper tract urothelial carcinoma detection in voided urine samples of Chinese patients.

OBJECTIVES: To evaluate a combined analysis approach that involves cytologic evaluation and fluorescence in situ hybridization analysis (FISH) for detecting urothelial carcinoma (UC) in the upper tract (UT). METHODS: By refining the UroVysion positive criteria, an analyzing modality (Cyto-FISH) combined urine cytology and FISH analysis (UroVysion probe set) was introduced and urine specimens from 71 patients with UT-UC and 45 controls were analyzed. Sensitivity and specificity of urine cytology, FISH, and Cyto-FISH were determined and compared, respectively. The features of chromosomal aberrations of malignant cells from UT-UC were also determined. RESULTS: Overall sensitivity of verified UT-UC by Cyto-FISH analysis was sharply higher than the single value for urine cytology (85.9% vs 45.1%, P <.001) and was slightly higher than FISH (85.9% vs 78.9%, P = .378). Sensitivities of cytology and Cyto-FISH by grade were 28.2% vs 74.4% for low-grade (P <.001), and 65.6% vs 96.9% for high-grade tumors (P = .003), respectively. The advantage maintains stably not only in the detection of nonmuscle-invasive tumors but in invasive tumors between cytology and Cyto-FISH (39.1% vs 76.1%, P = .001, and 53.8% vs 100%, P <.001, respectively). Specificities were 97.8%. In addition, polysomic chromosomal aberrations of the UT-UC cases could present a possible trend toward greater chromosome increased with tumor grades and progressive stages of invasion. CONCLUSIONS: Our results have shown that Cyto-FISH analysis for the presence of UC cells is a powerful tool, providing high sensitivity and specificity, and may offer a new scheme for the tough UT-UC diagnosis.

A novel training model for laparoscopic partial nephrectomy using porcine kidney.

PURPOSE: The purpose of this study was to create a simple model for teaching laparoscopic partial nephrectomy (LPN) for duplicating the blood supply setting and main technical points of the procedure. MATERIALS AND METHODS: A fresh porcine kidney was placed on an unfolded metallic box to help trainees observe, practice, and develop LPN skills in both tumor incision and suturing. The metallic box was specially designed not only for fixing and positioning the kidney but also for storing the outflow of the kidney while its artery was kept artificially infused. A spherical renal parenchyma excision about 2 cm in diameter was initially made and the suture-repairing work followed. This model was used by trainees who had fair laparoscopic competency after completing dry laboratory training programs. During a 20-day training period the trainees were assessed with respect to the time needed to complete LPN. A mentor-trainee fellowship program was planned to guarantee the success of the operations and the quality of LPN. RESULTS: There was a good reduction in the total operative time from the fourth to the last attempt. There was also increasing improvement in the quality of the incision suturing during the attempts. By the end of 10 attempts all trainees were more confident in completing a good quality LPN in a mean time of 28.4 minutes. CONCLUSION: This model not only offers trainees the opportunities to acquire the skills necessary for LPN but also provides for more economical practice by using easily available porcine kidney.