Background: To compare the safety and efficacy of retrograde intrarenal surgery (RIRS) and modified Ultra-mini percutaneous nephrolithotomy (UMP) in semi-supine combined lithotomy position for the management of 1.5–3.5 cm lower pole renal stones (LPSs).Methods: A total of 63 patients with 1.5–3.5 cm LPSs who underwent RIRS (n = 33) or modified UMP (n = 30) in diameter between January 2017 and January 2019 were analyzed retrospectively. Modified UMP was performed in semi-supine combined lithotomy position and a 9.5/11.5 F ureteral access sheath (UAS) was inserted during the procedure in order to maintain low pelvic pressure and to facilitate the removal of stone fragments. Base-line parameters, stone characteristics, illness condition, operation time, postoperative hemoglobin (Hb) drop, postoperative creatinine (Cr) elevation, length of hospital stay, length of postoperative hospital stay, stone-free rate (SFR) and complications were compared between the two groups.Results: There were no significant differences between the two groups in base-line parameters, stone characteristics and illness condition. The mean operating time of RIRS group was longer than UMP group (95.61 ± 21.9 vs. 55.0 ± 16.1 min,p < 0.001). The mean postoperative Hb drop was less in RIRS group (7.42 ± 4.7 vs. 15.70 ± 9.8 g/L,p < 0.001). The length of hospital stay and postoperative hospital stay for RIRS were shorter than UMP (4.76 ± 1.1 vs. 5.83 ± 0.8 d,p < 0.001, 2.97 ± 0.9 vs. 4.07 ± 0.9 d,p < 0.001). The Early SFR was higher in UMP group (54.5 vs. 80.0%,p < 0.050) while SFR at 1-month and 3-months postoperatively was similar in both groups (p = 0.504,p = 0.675). There were no significant differences between the two groups in complications (p = 0.228).Conclusion: For patients with 1.5–3.5 cm LPSs, both modified UMP and RIRS are safe and viable. The modified UMP technique was used in this study, application semi-supine combined lithotomy position and the retention of UAS can improve the surgical efficiency and maintain low pressure perfusion in the kidney, which resulted in superior treatment efficacy. Therefore, we highly recommend this technique for LPSs with heavy stone burdens.

Purpose: To explore the establishment of a scoring system that can provide a reference for clinical decision mak-ing regarding the endoscopic treatment of 1-2 cm lower pole stones (LPS).Materials and Methods: The data of patients with renal calculi who were treated with percutaneous nephrolithot-omy (PCNL) or retrograde intrarenal surgery (RIRS) in three hospitals from January 2013 to December 2017 were analyzed retrospectively. Multivariable logistic analysis was performed to determine the statistically significant indicators and regression coefficients, which were used to construct the scoring system. The stone-free rate (SFR) and postoperative complication rates of PCNL and RIRS within the two fractional segments of the scoring system were compared to select the optimal procedures.Results: A total of 137 patients in the PCNL group and 152 patients in the RIRS group were included in this study. Five factors were found to be most predictive of endoscopic treatment choice: stone number, stone diameter, infun-dibulopelvic angle (IPA), infundibular length (IL), and infundibular width (IW), yielding a total score ranging from 0-5. In the 0-2 segments, the RIRS group had better outcomes than the PCNL group in terms of the postoperative complication rates (6.8% versus 18.0%, P = .026). In segments 3-5, the SFR of the PCNL group was significantly higher than that of the RIRS group (88.5% versus 70.6%, P = .017).Conclusion: Our scoring system was based on the patient's preoperative imaging examination to measure the stone number, stone diameter, IPA, IL and IW. RIRS was recommended at 0-2 segments, and PCNL was recom-mended at 3-5 segments. This new scoring system is expected to provide guidance for urologists to make endo-scopic treatment decisions for 1-2 cm LPS.

Background Prostate cancer is a prominent global health concern, posing a substantial threat to men's well-being and longevity. N-7methylguanosine (m7G) modification orchestrated by a complex involving METTL1 and WDR4, has garnered attention as a post-transcriptional modification with implications in numerous tumor types. Nevertheless, there is a paucity of research addressing potential pivotal roles of METTL1 and WDR4 in driving prostate cancer progression. Methods We obtained mRNA expression data for METTL1 and WDR4 from the TCGA and GSEA databases in prostate cancer patients, analyzing their impact on survival and tumor immune microenvironment. GO and KEGG analyses were performed on associated genes. Univariate and multivariate Cox analyses identified METTL1 and WDR4 as independent prognostic factors, leading to a two-gene predictive model that evaluated tumor mutation burden, immune infiltration, and immune function changes. Importantly, we substantiated the impact of METTL1 and WDR4 on prostate cancer development in vitro. Results In prostate cancer, high METTL1 and WDR4 expression correlated with reduced overall survival and increased plasmacytoid dendritic cells, with decreased adaptive immune cells. Functional enrichment analysis indicated their influence on ribosome-related functions. Our model revealed critical mutation sites and immune infiltration alterations. In vitro, METTL1 or WDR4 knockdown inhibited prostate cancer cell proliferation, migration, and invasion. Conclusion Our study unveils the oncogenic roles of both METTL1 and WDR4 in prostate cancer development. Additionally, the prognostic model founded on METTL1 and WDR4 exhibits enhanced predictive precision for OS, thereby serving as a valuable clinical tool for prostate cancer.

Purpose: To describe the feasibility of computed tomography (CT)-ultrasound image fusion technique on guiding percutaneous kidney access in vitro and vivo.Materials and Methods: we compare CT-ultrasound image fusion technique and ultrasound for percutaneous kid-ney puncture guidance by using an in vitro pig kidney model. The fusion method, fusion time, ultrasound screening time, and success rate of puncture were compared between the groups. Next, patients with kidney stones in our hospital were randomized in the study of simulated puncture guidance. The general condition of patients, fusion method, fusion time, and ultrasound screening time were compared between the groups.Results: A total of 45 pig models were established, including 23 in the CT-ultrasound group and 22 in the ultra-sound group. The ultrasound screening time in the CT-ultrasound group was significantly shorter than that in the ultrasound group (P < .001). In addition, the success rate of puncture in the CT-ultrasound group was significantly higher than that in the ultrasound group (P =.015). Furthermore, in the simulated PCNL puncture study, baseline data including age, BMI, and S.T.O.N.E score between the two groups showed no statistical difference. The ultra-sound screening time of the two groups was (2.60 & PLUSMN; 0.33) min and (3.37 & PLUSMN; 0.51) min respectively, and the differ-ence was statistically significant (P < .001).Conclusion: Our research revealed that the CT-ultrasound image fusion technique was a feasible and safe method to guide PCNL puncture. Compared with traditional ultrasound guidance, the CT-ultrasound image fusion tech-nique can shorten the learning curve of PCNL puncture, improve the success rate of puncture, and shorten the ultrasound screening time.

Background：To compare the safety and efficacy of retrograde intrarenal surgery (RIRS) and modified Ultra-mini percutaneous nephrolithotomy (UMP) in semi-supine combined lithotomy position for the management of 1.5-3.5 cm lower pole renal stones (LPSs). Methods: A total of 63 patients with 1.5-3.5 cm LPSs who underwent RIRS (n= 33) or modified UMP (n= 30) in diameter between January 2017 and January 2019 were analyzed retrospectively. Modified UMP was performed in semi-supine combined lithotomy position and a 9.5/11.5 F ureteral access sheath (UAS) was inserted during the procedure in order to maintain low pelvic pressure and to facilitate the removal of stone fragments. Base-line parameters, stone characteristics, illness condition, operation time, postoperative hemoglobin (Hb) drop, postoperative creatinine (Cr) elevation, length of hospital stay, length of postoperative hospital stay, stone-free rate (SFR) and complications were compared between the two groups. Results: There were no significant differences between the two groups in base-line parameters, stone characteristics and illness condition. The mean operating time of RIRS group was longer than UMP group (95.61 ± 21.9 vs. 55.0 ± 16.1 min, p< 0.001). The mean postoperative Hb drop was less in RIRS group (7.42 ± 4.7 vs. 15.70 ± 9.8 g/L, p< 0.001). The length of hospital stay and postoperative hospital stay for RIRS were shorter than UMP (4.76 ± 1.1 vs. 5.83 ± 0.8 d, p< 0.001, 2.97 ± 0.9 vs. 4.07 ± 0.9 d, p< 0.001). The Early SFR was higher in UMP group (54.5 vs. 80.0%, p< 0.050) while SFR at 1-month and 3-months postoperatively was similar in both groups (p= 0.504, p= 0.675). There were no significant differences between the two groups in complications (p= 0.228). Conclusion：For patients with 1.5-3.5 cm LPSs, both modified UMP and RIRS are safe and viable. The modified UMP technique was used in this study, application semi-supine combined lithotomy position and the retention of UAS can improve the surgical efficiency and maintain low pressure perfusion in the kidney, which resulted in superior treatment efficacy. Therefore, we highly recommend this technique for LPSs with heavy stone burdens.