With the ongoing reform of clinical medical education in China, the training model for Clinical Professional Master’s Degree Residents (CPMDRs) has become a crucial component of medical education. as a core technique in modern surgical practice, plays a pivotal role in standardized residency training. However, CPMDRs often face challenges in efficiently mastering laparoscopic skills within a limited training period. This study aims to evaluate the effectiveness of a progressive laparoscopic training program in enhancing the skills of CPMDRs and to explore its implications for clinical medical education in China. A three-month progressive laparoscopic training program was designed, incorporating multiple teaching methods such as knowledge acquisition, box trainer training, virtual reality (VR) simulation, ex vivo organ training, and animal-based surgical training. A total of 25 CPMDRs participated in the program. Their laparoscopic skills were evaluated before and after the training using task completion times and standardized performance metrics. In addition, a questionnaire was administered to assess participants’ satisfaction with the program and their perceived improvement in competency. Following the training, participants demonstrated significant reductions in task completion times across all laparoscopic tasks (P < 0.001), particularly in visual targeting, precision transfer drills, and interrupted suturing. The program received high satisfaction ratings, with 80% of participants strongly agreeing that it stimulated their interest in learning. Furthermore, participants reported marked improvements in basic laparoscopic techniques, VR-based surgical skills, and animal-based procedural abilities. The progressive laparoscopic training program effectively enhanced the laparoscopic skills of CPMDRs and received high approval from participants. By employing a multidimensional teaching approach, this training model is adaptable to the resource conditions of different regions in China, demonstrating broad potential for widespread adoption. This study provides scientific evidence and practical support for optimizing the laparoscopic skills training system for CPMDRs in China.

Rationale: Staghorn calculi are a challenging type of kidney stone traditionally treated with percutaneous nephrolithotomy (PCNL) or multiple endoscopic procedures. However, these methods are often associated with a higher risk of postoperative complications and prolonged recovery periods. Recent advancements in flexible ureteroscopy (fURS) technology have offered the potential for improving the management of kidney stones, but its application in treating complex staghorn stones remains limited due to technical and anatomical challenges. Patient concerns: A patient presented with bilateral staghorn calculi, which posed significant challenges for treatment due to their size and complexity. The patient was concerned about the risks associated with the traditional methods, including postoperative infection, long recovery times, and potential complications. Diagnoses: The patient was diagnosed with bilateral staghorn calculi, large and complex stones that require a highly specialized approach for effective treatment. Interventions: A novel approach was used to manage the patient’s bilateral staghorn calculi using a 6.3 Fr flexible ureteroscope. Complete stone clearance was achieved using 2 procedures. The smaller sheath diameter of the 6.3 Fr flexible ureteroscope provides several advantages, including improved lithotripsy efficiency, reduced intrarenal pressure, and enhanced irrigation flow. Outcomes: Use of the 6.3 Fr flexible ureteroscope resulted in complete stone clearance with minimal postoperative complications, such as infection. This procedure demonstrated high efficiency and precision, highlighting the potential of advanced fURS technology for the treatment of complex kidney stones. Lessons: This case highlights the advantages of utilizing the 6.3 Fr flexible ureteroscope in the management of complex kidney stones, particularly staghorn calculi. These findings suggest a higher single-stage surgical success rate and fewer postoperative complications. This approach reflects the evolving field of endourology and demonstrates the potential for broader applications of the advanced fURS technology.

Background: Glutathione S-transferase Pi-1 (GSTP1) methylation is detectable in prostate cancer (PCa) tissues, blood, and urine post-prostate massage, with elevated levels in urine samples. But its role in urine samples for PCa diagnosis is still unclear. This study aimed to investigate the clinical significance of urine-based automated detection of GSTP1 methylation technology in the diagnosis of clinical suspected PCa patients. Methods: A retrospective study was performed on 120 patients who underwent prostate biopsy at The University of Hong Kong-Shenzhen Hospital from September 2022 to June 2024. All patients underwent digital rectal examination (DRE) prior to biopsy, with post-DRE urine samples used for GSTP1 methylation testing. Using biopsy pathology as the gold standard, we compared the sensitivity, specificity, and accuracy of urinary GSTP1 methylation with prostate-specific antigen (PSA) for diagnosing PCa. Additionally, we developed a diagnostic prediction model integrating urinary GSTP1 methylation and PSA to assess the combined method’s value in enhancing diagnostic efficacy. Results: The sensitivity and specificity of urinary GSTP1 methylation for PCa diagnosis were 81.4% and 83.6%, respectively, with positive predictive value (PPV) of 82.8% and accuracy of 82.5%. In contrast, PSA had sensitivity and specificity of 67.8% and 54.1%, respectively, with PPV of 58.8% and accuracy of 60.8%. Urinary GSTP1 methylation showed no significant difference in sensitivity compared to PSA (P=0.16) but significantly higher specificity (P=0.001). In the PSA gray zone (4.0–10.0 ng/mL), GSTP1 methylation had sensitivity and specificity of 87.5% and 86.2%, respectively, achieving accuracy of 86.7%, demonstrating good diagnostic efficacy. The area under the curve (AUC) for the combined urinary GSTP1 methylation and PSA method was 0.89 [95% confidence interval (CI): 0.84–0.95], P<0.001, significantly superior to PSA alone, notably improving diagnostic efficacy. Conclusions: Automated detection of urinary GSTP1 methylation significantly enhanced PCa diagnostic value, outperforming PSA in sensitivity, specificity, and accuracy. Combining urinary GSTP1 methylation with PSA notably improved accuracy, especially in the PSA gray zone (4.0–10.0 ng/mL), demonstrating excellent efficacy. This non-invasive, easily performed method showed high diagnostic efficacy, indicating strong clinical potential.

Background: Enhanced recovery after surgery (ERAS) has been widely applied in various surgical fields to improve postoperative recovery and reduce complications. However, its application in retroperitoneal laparoscopic resection of adrenal tumors remains limited. This study aimed to evaluate the effect and value of the 4N-ERAS protocol, which includes no Foley catheter, no drainage, no antibiotics, and “no pain” management for the postoperative recovery of patients undergoing retroperitoneal laparoscopic adrenal tumors resection. Methods: We retrospectively analyzed data from 85 patients with adrenal tumors who were treated in the Urology Department of The University of Hong Kong-Shenzhen Hospital from January 2019 to December 2023. Of them, 42 patients were treated with the 4N-ERAS protocol (4N-ERAS group) and 43 patients received traditional treatment (control group). We compared clinical characteristics, such as sex, age, mean body mass index (BMI), preoperative diagnosis, tumor size, tumor location, and postoperative outcomes, including time to first flatus, time to first ambulation, time to Foley catheter removal, time to retroperitoneal drainage tube removal, postoperative pain score [Numeric Rating Scale (NRS)], length of hospital stay, total hospitalization costs, and postoperative complications between the two groups. Results: There were no significant differences in terms of clinical characteristics between the two groups. Compared to the control group, the 4N-ERAS group exhibited shorter times for first flatus, first ambulation, Foley catheter removal, retroperitoneal drainage tube removal, lower postoperative pain scores (NRS), and shorter hospital stays (P<0.05). Furthermore, compared to the control group, the total hospitalization cost was significantly lower in the 4N-ERAS group (P<0.05). There were no significant differences in terms of postoperative complications between the two groups (P=0.19). Conclusions: The 4N-ERAS protocol for retroperitoneal laparoscopic resection of adrenal tumors may expedite postoperative recovery, reduce pain, and lower overall hospital costs. This preliminary study demonstrated the safety and feasibility of the 4N-ERAS protocol for retroperitoneal laparoscopic resection of adrenal tumors, warranting future multicenter prospective, randomized, controlled trials in this field.

Objective: To explore the clinical application of enhanced recovery after surgery (ERAS) in bipolar transurethral vaporization of the prostate (B-TUVP) and its impact on postoperative recovery. Methods: A retrospective analysis was conducted on the clinical data of 212 patients with benign prostatic hyperplasia (BPH) admitted to the Department of Urology of our hospital from January 2019 to December 2024. Among them, 121 patients were managed under an ERAS protocol (ERAS group), and 91 patients received traditional perioperative care (control group). The clinical characteristics included age, mean body mass index (BMI), preoperative comorbidities, prostate volume (PV), preoperative International Prostate Symptom Score (IPSS), preoperative Quality of Life (QoL) score, preoperative urinary flow rate, and urodynamic parameters. Preoperative management, intraoperative management, and postoperative outcomes were compared between the two groups. Results: The clinical baseline data showed no significant differences between the two groups. Compared with the control group, the ERAS group had a significantly shorter duration of continuous bladder irrigation, time to first ambulation, and postoperative length of stay ( P < 0.001). The total hospitalization costs were also significantly lower in the ERAS group compared to the control group ( P < 0.01). There was no significant difference in the incidence of postoperative complications between the two groups. Conclusion: The application of the ERAS protocol in B-TUVP can promote postoperative recovery, reduce the postoperative length of stay, and decrease total hospitalization costs. However, more prospective randomized controlled trials are needed to further validate the feasibility and effectiveness of this protocol.