SPAG9 promotes prostate cancer proliferation and metastasis via MAPK signaling pathway.

Prostate cancer (PCa) is a worldwide malignant tumor which seriously threats the reproductive health of middle-aged and senior male. Sperm-associated antigen 9 (SPAG9), which belongs to the cancer testis (CT) antigen, overexpressed in multiple human malignant tumors and promoted tumor proliferation, invasion and metastasis. However, little attention has been focused on the relationship between SPAG9 and PCa. SPAG9 protein level was measured by immunohistochemical staining in the PCa tissues. SPAG9 mRNA and protein expression were investigated in various PCa cells by qRT-PCR and Western blot. Depletion and overexpression of SPAG9 were proceeded in PCa cells to evaluate their effects by various malignant approaches in vitro and in vivo. SPAG9 was significantly upregulated in the PCa tissues, mainly expressed in the cytoplasm and occasionally in the nucleus of some cells, while SPAG9 was not detected in normal prostate tissue. SPAG9 protein was detected in three PCa cells. Furthermore, these results revealed that upregulation of SPAG9 could promote cell proliferation, migration, motility and cycle of PC-3 cell line, vice versa, downregulation of SPAG9 resulted in the opposite effect. In vivo, knockout of SPAG9 expression induced suppression of tumor growth in athymic nude mice. In summary, the present study indicated that SPAG9 was closely related to the Gleason scores of PCa. SPAG9 could promote cell proliferation, migration, motility and cell cycle via MAPK signaling pathway, suggesting that SPAG9 may be a potential therapeutic target for PCa.

Statin and metformin therapy in prostate cancer patients with hyperlipidemia who underwent radiotherapy: a population-based cohort study.

PURPOSE: To evaluate the association between the use of statins and/or metformin and patient survival in prostate cancer patients in Taiwan. SUBJECTS AND METHODS: Newly diagnosed prostate cancer patients who had hyperlipidemia and received radiotherapy were identified from the National Health Insurance Research Database 2000-2010. The survival rate was estimated by the Kaplan-Meier method. Univariate and multivariate Cox regression analyses were performed to examine the association of mortality. Sensitivity analysis was performed to assess the risk of mortality in patients with diabetes. RESULTS: The study included 567 patients. Patients who used statins or metformin after prostate cancer diagnosis had longer average survival times (9.3 years and 8.1 years, respectively; P=0.001) compared with patients who persistently used or used the medicines prior to cancer diagnosis. Multivariate Cox regression analysis found that patients treated with statins after cancer diagnosis were significantly associated with a lower risk of mortality (aHR =0.24, 95% CI =0.09-0.66) compared to patients who did not use statins during the study period. Patients treated with metformin after cancer diagnosis were significantly associated more with an increased risk of mortality (aHR =6.78, 95% CI =2.45-18.77) compared to patients who did not use metformin during the study period. Sensitivity analysis revealed that the average survival time was similar among different medicine use groups in patients with diabetes. CONCLUSION: The finding suggests that statins and metformin use after prostate cancer diagnosis may increase survival in patients with hyperlipidemia and radiotherapy.

Upregulated circular RNA circ-102004 that promotes cell proliferation in prostate cancer.

OBJECTIVE: Prostate cancer (PCa) is one of the most prevalent cancers affecting men worldwide. However, the biological functions of circRNAs in PCa are still largely unknown. METHODS: Real-time PCR (RT-PCR) and immunohistochemistry were performed to characterize the circ-102004 expression in both human PCa tissues and cell lines. The apoptosis and cell cycle status of prostate immortalized cell lines that were overexpressed with circ-102004 by transfection was analyzed using flow cytometry. The scratch test and the Transwell assay were conducted to evaluate the ability of transfected cells to migrate and invade. RNA sequencing, pathway analysis, and Western blotting were performed to probe the associations of circ-102004 with the classical cancer signaling pathways after functionally evaluating circ-102004 in a xenograft tumor model. RESULTS: In the present study, circ-102004 expression was found to be significantly higher in PCa samples than in the matched normal tissues. In functional experiments, circ-102004 is shown to play an oncogenic role in PCa by stimulating cancer cell migration and invasion. Circ-102004 overexpression was also accompanied by significant alterations in many signaling pathways, such as ERK, JNK, and Hedgehog, which are known to cause different types of cancers. CONCLUSIONS: Circ-102004 is a potential oncogenic gene that regulates the development and progression of PCa. This study provides a scientific basis for targeting circ-102004 for either diagnosis or therapy.

Impact and Predictive Value of Prostate Weight on the Outcomes of Nerve Sparing Laparoscopic Radical Prostatectomy in Patients with Low Risk Prostate Cancer.

PURPOSE: To investigate the impact of prostate weight on outcomes of nerve sparing laparoscopic radical prosta-tectomy (LRP) and assess its predictive value on postoperative continence and potency recovery. MATERIALS AND METHODS: We conducted a retrospective study on the clinical data of 165 patients with low risk prostate cancer (PCa) who underwent nerve sparing LRP. All the patients included had normal preoperative uri-nary and sexual function. The association of prostate weight with perioperative data was assessed using Spearman correlation coefficient. Univariate and multivariate Cox regression analyses were employed to identify prognostic predictors for continence and potency recovery. RESULTS: Increased prostate weight was significantly associated with older age, higher prostate-specific antigen (PSA), lower biopsy and pathological T stage and Gleason score, longer operative time, and higher estimated blood loss (P < .05). The continence rates at the 3rd, 6th, and 12th month after surgery were 63.6% (105/165), 87.9% (145/165), and 95.8% (158/165); and the potency rates were 44.8% (74/165), 62.4% (103/165) and 77.6% (128/165), respectively. Furthermore, multivariate Cox analysis showed that patient age (HR = 0.52, 95% CI: 0.35- 0.76) and prostate weight (HR = 0.54, 95% CI: 0.34-0.86) were independent predictors for continence recovery, while only patient age (HR = 0.66, 95% CI: 0.45-0.96) could independently predict potency recovery. CONCLUSION: Larger prostate size was correlated with older age, higher PSA, lower tumor stage and grade, longer operative time, and more intraoperative blood loss in low risk PCa patients. Increased prostate weight may inde-pendently predict poor continence recovery after nerve sparing LRP.

A modification with threading cannula needle-assisted 4-point suspension fixation for retroperitoneal laparoscopic pyeloplasty in children with ureteropelvic junction obstruction: a cohort study in single center.

PURPOSE: To evaluate the effect and safety of modifying a threading cannula needle-assisted suspension fixation in retroperitoneal laparoscopic dismembered pyeloplasty (LDP) for children with congenital ureteropelvic junction obstruction (UPJO). METHODS: Between December 2012 and December 2017, 45 children (< 14 years of age) with congenital UPJO were divided into two groups. In Group A, children underwent conventional "no-suspension fixation" LDP; and in Group B, "4-point suspension fixation" LDP was performed to lower difficulties and shorten operative time. The perioperative clinical data were recorded and analyzed. RESULTS: No statistical difference was found between two groups in preoperative characteristics. The duration of surgery, operative time for completion of anastomosis and the length of postoperative hospital stay in Group B was remarkably shortened than that in Group A, respectively (P < 0.05 for all). There was no significant difference between two groups in terms of postoperative renal pelvic diameter (RPD) decreasing, extubation time and success rates of surgery (P > 0.05 for all). In addition, no recurrent stenosis and urine leakage in both groups, and the postoperative RPD remained at the low level in both groups during the period of follow-up. CONCLUSIONS: Our modification of the 4-point suspension fixation for retroperitoneal LDP is an effective and safe method for children with UPJO. It can simplify the surgical procedures, lower difficulties (especially in precise anastomotic suturing) and shorten the learning curve. This modification might be of particular interest to urologists for improving treatment of children with UPJO.

A Novel Modification of Transurethral Enucleation and Resection of the Prostate in Patients With Prostate Glands Larger than 80 mL: Surgical Procedures and Clinical Outcomes.

OBJECTIVE: To evaluate the efficacy and safety of the modified transurethral enucleation and resection of the prostate (M-TUERP) vs the conventional bipolar transurethral resection of the prostate (B-TURP) for the treatment of prostates larger than 80 mL. METHODS: From April 2012 to May 2014, 86 patients with a prostate volume of >80 mL were divided into 2 groups to undergo M-TUERP and B-TURP. In the M-TUERP group, we proposed combining the 12-mm trocar suprapubic cystostomy and using the techniques of "umbrella-shaped resection," "point resection," and "segmental enucleation" to modify the transurethral enucleation and resection of the prostate procedure. The perioperative clinical data were recorded and analyzed. RESULTS: There were no significant differences in preoperative characteristics between the 2 groups. Both groups were similar with the operative time. The M-TUERP group was significantly superior to the B-TURP group in terms of the weight of the resected tissue, the mean intraoperative bladder pressure, hemoglobin decrease, bladder irrigation duration, and urethral catheterization time. No transurethral resection syndrome and incontinence occurred in either group. Compared with the B-TURP group, none of the patients in the M-TUERP group suffered blood transfusion, clot retention, recatheterization, dysuria and reoperation. At the 3-year follow-up, patients who underwent M-TUERP had better international prostate symptom scores, maximum urinary flow rates, and quality of life scores. CONCLUSION: Our modification of the transurethral enucleation and resection of the prostate procedure is a safe and effective method for the surgical treatment of large-volume benign prostatic hyperplasia. It can simplify the surgical procedures, reduce complications, lower difficulties and shorten the learning curve. At 3-year follow-up, the M-TUERP shows a superior and durable clinical outcome than the B-TURP.

Identification of endonuclease domain-containing 1 as a novel tumor suppressor in prostate cancer.

BACKGROUND: Endonuclease domain containing 1 (ENDOD1) is implicated in tumorigenesis and aggressiveness of multiple tumors. In this study, we aimed to investigate the role of ENDOD1 in prostate cancer (PCa). METHODS: Immunohistochemistry were performed in 30 cases of benign prostatic hyperplasia (BPH) and 50 cases of PCa to identify its association with clinicopathological characteristics. Real-time PCR and western blot were used to detect ENDOD1 mRNA and protein expression in normal prostatic epithelial and PCa cell lines. MTT assays were employed to determine the effect of cell proliferation. Flow cytometry was used to explore the cell cycle distribution and apoptotic effects. Transwell migration and invasion assays were done to evaluate changes in the ability of cell migration and invasion. RESULTS: Immunoreactivity scores of ENDOD1 showed no statistical difference between BPH and low-grade PCa, whereas lower immunostaining scores were observed in high-grade compared with low-grade PCa. Real-time PCR data indicated that ENDOD1 mRNA expression was markedly increased in LNCaP and 22Rv1 cells and decreased in PC3 and DU145 cells compared to the normal epithelial cells RWPE1. Western blot showed that androgen-sensitive LNCaP cells had the highest protein expression level of ENDOD1, whereas castration-resistant PCa cell lines PC3 and DU145 had significantly lower protein levels. Meanwhile, overexpression of ENDOD1 suppressed cell proliferation, induced G0/G1 cell cycle arrest and inhibited cell migration and invasion. Conversely, siRNA-mediated silencing of ENDOD1 promoted cell proliferation, migration and invasion. No apoptotic effects occurred upon manipulation of ENDOD1 expression. CONCLUSION: Our results indicate that ENDOD1 is a novel tumor suppressor in PCa, which may be employed as a new drug target of preventing progression to metastatic castration-resistant prostate cancer.

Silencing of CDC20 suppresses metastatic castration-resistant prostate cancer growth and enhances chemosensitivity to docetaxel.

The role of cell division cycle 20 (CDC20) was investigated in chemoresistance to decetaxel and the underlying mechanisms in metastatic castration-resistant prostate cancer (mCRPC). MTT assays were performed to determine effects of siRNA-mediated CDC20 knockdown on cell proliferation and anticancer activity of docetaxel. Western blot analyses were conducted to detect changes of Akt and Wnt signaling. Furthermore, in vivo growth of PCa was examined in nude mice treated with siCDC20 or docetaxel alone or in combination. CDC20 was overexpressed in mCRPC cells. Knockdown of CDC20 suppressed cell proliferation and enhanced anticancer effect of docetaxel with IC50 reducing from 0.358 to 0.188 µg/ml in PC3 cells and 0.307 to 0.162 µg/ml in DU145 cells (P<0.01). While no change of Akt signaling was observed, inhibition of Wnt/ß-catenin signaling was detected upon CDC20 silencing. Xenograft tumor growth was significantly reduced in nude mice by CDC20 inhibition. The additional treatment of siCDC20 achieved better anticancer effects than that of docetaxel alone. Silencing of CDC20 may be a new strategy to improve chemosensitization to docetaxel in mCRPC.

Overexpression of Cdc20 in clinically localized prostate cancer: Relation to high Gleason score and biochemical recurrence after laparoscopic radical prostatectomy.

OBJECTIVES: This study was aimed to explore Cdc20 expression and its correlation with clinicopathological characteristics and biochemical recurrence (BCR) after laparoscopic radical prostatectomy (LRP) in clinically localized prostate cancer (PCa). METHODS: Cdc20 expression was examined by immunohistochemistry in 166 cases, including 60 cases of benign hyperplasia of prostate (BPH) patients treated by transurethral resection and 106 cases of consecutive PCa patients treated by LRP without neoadjuvant therapy in a single Chinese institution. The correlation with clinicopathological features and the predictive value for BCR were statistically analyzed. RESULTS: Cdc20 expression was detected in 52 (86.7%) BPH and 97 (91.5%) PCa samples, which was statistically insignificant (P= 0.675). The rate of patients with high expression of Cdc20 was 21.7% in BPH and 37.7% in PCa (P= 0.033). A correlation was revealed between Cdc20 expression and postoperative Gleason scores (P= 0.046), positive surgical margin (P< 0.001). BCR-free survival was significantly lower in patients with high Cdc20 expression than those with low Cdc20 expression (P= 0.018). Univariate analysis indicated pTstage, post operative Gleason score, seminal vesicle invasion, lymph node invasion, surgical margin and Cdc20 expression significantly influenced BCR. Multivariate analysis revealed that postoperative Gleason score, seminal vesicle invasion, lymph node invasion, surgical margin and Cdc20 expression were independent predictors for BCR. After stratified by Gleason score and surgical margin status, Cdc20 expression and lymph node invasion remained significant in Cox regression analysis. CONCLUSIONS: Overexpression of Cdc20 may serve as an independent predictor for BCR in patients of clinically localized PCa undergoing LRP without neoadjuvant therapy.

Laparoscopic Radical Prostatectomy after Previous Transurethral Resection of the Prostate in Clinical T1a and T1b Prostate Cancer: A Matched-Pair Analysis.

PURPOSE: To analyze and compare surgical, oncological and functional outcomes of laparoscopic radi­cal prostatectomy (LRP) in patients with and without previous transurethral resection of the prostate (TURP). MATERIALS AND METHODS: In total, 785 men underwent LRP at our institution from January 2002 to December 2012. TURP had been performed previously in 35 of these patients (TURP group). A matched-pair analysis iden­tified 35 additional men without previous TURP who exhibited equivalent clinicopathological characteristics to serve as a control group. Perioperative complications and surgical, functional, and oncological outcomes were compared between the two groups. RESULTS: The groups were similar in age, body mass index, serum prostate-specific antigen level, and pre- and post-operative Gleason scores. Patients in the TURP group had greater blood loss (231 vs. 139 mL), longer opera­tive times (262 vs. 213 min), a greater probability of transfusion (8.6% vs. 0%), and a higher rate of complications (37.1% vs. 11.4%) compared with the control group. The positive surgical margin rate was higher in the TURP group, but this difference was not statistically significant (P = .179). The continence rates at one year after surgery were similar, but a lower continence rate was identified in the TURP group (42.9% vs. 68.6%) at 3 months. Bio­chemical recurrence developed in 17.1% and 11.4% of the patients in the TURP and control groups, respectively, after a mean follow-up of 57.6 months. CONCLUSION: LRP is feasible but challenging after TURP. LRP entails longer operating times, greater blood loss, higher complication rates and worse short-term continence outcomes. However, the radical nature of this cancer surgery is not compromised.

Predictors of urinary continence recovery after modified radical prostatectomy for clinically high-risk prostate cancer.

PURPOSE: To retrospectively determine predictors of urinary continence (UC) recovery in clinically high-risk prostate cancer (PCa) patients treated with modified radical prostatectomy (RP). MATERIALS AND METHODS: A total of 184 patients with clinically high-risk PCa who underwent modified RP in a single Chinese center were retrospectively reviewed. Pelvic floor muscle training with biofeedback was routinely performed after catheter removal. UC was defined as wearing 0 or 1 protective pad daily. Univariate and multivariate Cox regression analyses were performed to determine the predictors of UC recovery. RESULTS: The median age at surgery was 69.5 years (range 48-82), and the median follow-up duration was 40 months (range 12-111). Only 40 patients (21.7%) received a nerve-sparing procedure. For patients with restored UC, the median time to continence was 1 month (range 1-24). UC recovery at 1 month, 6 months, 12 months and the most recent follow-up was observed in 99 (53.8%), 158 (85.9%), 171 (92.9%) and 174 (94.6%) patients, respectively. Multivariate Cox regression analysis showed that patient age < 70 years (hazard ratio 1.684, P = .003) and smaller prostate volume (hazard ratio 0.989, P = .036), but not the surgical approach or treatment with a nerve-sparing procedure, independently predicted UC recovery. CONCLUSION: Age < 70 years and smaller prostate volume were independent predictors of UC recovery in clinically high-risk PCa patients. The adverse factors of high-risk disease were not significantly associated with UC recovery. These results may help surgeons preoperatively counsel patients regarding expected UC outcomes following RP. 

Single-port transvesical laparoscopic radical prostatectomy for organ-confined prostate cancer: technique and outcomes.

OBJECTIVE: To report a novel technique for performing single-port transvesical laparoscopic radical prostatectomy (STLRP) and to evaluate the oncological and functional outcomes in 16 patients with organ-confined prostate cancer. PATIENTS AND METHODS: In total, 16 consecutive patients with clinical stage T1-2aN0M0 were scheduled for STLRP, and their continence and erectile status were investigated preoperatively. The patients' mean age was 62 years, mean prostate volume 42 mL and mean prostate-specific antigen (PSA) 7.5 ng/mL. The STLRP procedures were performed by a single surgeon, and all the operating procedures were conducted transvesically and laparoscopically. Intra-operative and postoperative complications, assessed according to the modified Clavien system, were recorded and peri-operative and functional outcome data were analysed. All patients were followed up for a minimum of 12 months postoperatively through PSA detection, daily pads, the International Index of Erectile Function (IIEF)-6 score and urography. RESULTS: All of the 16 STLRP procedures were successfully completed. The mean (range) operation duration was 105 (75-180) min, and the mean (range) estimated blood loss was 130 (75-500) mL. No patients had positive surgical margins. Postoperative complications occurred in five patients, including three cases of urinary infection and two cases of haematuria (grade II). Catheters were removed after a mean (range) time of 11.2 (9-14) days with cystography. The mean (range) hospital stay was 12.7 (10-15) days. Of the 16 patients, 13 were immediately continent (0 pads/day), and three had mild incontinence (2-3 pads/day) after catheter removal. All patients were observed as continent 3 months postoperatively. In total, 10/16 and 12/16 patients achieved a satisfactory erection at 6 and 12 months follow-up postoperatively, respectively, with an IIEF-6 score ≥ 18. The mean postoperative PSA levels at 3, 6 and 12 months were 0.015 ng/mL, 0.017 ng/mL and 0.016 ng/mL, respectively. No patients were identified with biochemical recurrence in this series. No patients demonstrated vesico-urethral stricture during follow-up for 12-24 months. CONCLUSIONS: We conclude that STLRP is technically feasible for patients with low-risk organ-confined prostate cancer and demonstrates promising functional outcomes regarding continence and potency.

Laparoscopic radical prostatectomy plus extended lymph nodes dissection for cases with non-extra node metastatic prostate cancer: 5-year experience in a single Chinese institution.

OBJECTIVE: To investigate the functional and oncologic outcomes of patients with locally advanced or lymph node metastatic prostate cancer (PCa) treated by laparoscopic radical prostatectomy (LRP) in a single Chinese institution. METHODS: From June 2004 to June 2011, a total of 152 cases including 105 locally advanced PCa and 47 lymph node metastatic PCa who were treated by LRP with extended lymph node dissection (ePLND) were enrolled in this study. Surgical records, urinary continence, complications, and oncologic outcomes were presented. RESULTS: The mean operation time and bleeding were 240 min and 110 ml, respectively. After 12-87 months (median 48 m) of follow-up, 91.4 and 94.7 % of the patients were urinary continence at 6 and 12 m, respectively. Eighty biochemical recurrent diseases were observed. The 3- and 5-year biochemical progression-free survival rates were 59.2 and 47.3 %, respectively. Multivariate analysis showed that Gleason score (HR: 1.66, 95 % CI: 1.05-2.64, P = 0.031), pathological stage (HR: 1.64, 95 % CI: 1.2-2.23, P = 0.002), and surgical margin status (HR: 1.75, 95 % CI: 1.04-2.95, P = 0.035) were independent predictive factors for subsequent biochemical relapse. The 3- and 5-year overall and cancer-specific survival rates were 90.2, 86.0 and 95.8, 92.3 %, respectively. There were no significant differences in biochemical recurrence-free (42.6 vs. 49.5 %, P = 0.491), overall (83.4 vs. 87.3 % P = 0.503), and cancer-specific survival rates (92.3 vs. 94.9 %, P = 0.801) between lymph node-positive and -negative PCa. CONCLUSION: With favorable functional and oncologic outcomes in this cohort of 152 patients, we concluded that LRP plus ePLND is feasible for patients with locally advanced non-extra node metastatic PCa.

Laparoscopic extraperitoneal repair of symptomatic hydrocele in children: a single-center experience with 73 surgeries.

PURPOSE: To introduce a novel, two-port laparoscopic technique for treatment of hydrocele in children, which allows completely extraperitoneal closure of the patent processus vaginalis (PPV) and does not necessitate laparoscopic suturing skills. PATIENTS AND METHODS: We describe a consecutive series of 56 boys with a median age of 36 months (range 12-144 mos) who presented with a presumably communicating hydrocele. Laparoscopic repair of these hydroceles was performed between July 2009 and June 2010. During surgery, a 5-mm laparoscope and a 3-mm grasping forceps were inserted through an identical umbilical incision (10 mm). The hydrocele sac orifice was closed extraperitoneally by circuit suturing around the internal inguinal ring. RESULTS: All cases were preoperatively diagnosed to be unilaterally based on physical examination and ultrasonography. During surgery, 17 of the 56 (30%) patients presented a contralateral PPV. A total of 73 laparoscopic procedures were achieved, with a success rate of 100%. The mean operative time was 25±6 and 36±5 minutes for unilateral and bilateral operations, respectively. During a median follow-up period of 6 months (range 1-12 mos), neither recurrence nor other postoperative complication was encountered. CONCLUSIONS: Our limited experiences suggest that the two-port, totally extraperitoneal laparoscopic technique could be a safe, effective, and reliable alternative for management of pediatric hydrocele.

Single-centre study comparing standard apical dissection with a modified technique to facilitate vesico-urethral anastomosis during laparoscopic radical prostatectomy.

A modified apical dissection of the prostate to improve the efficiency of vesico-urethral anastomosis (VUA) in laparoscopic radical prostatectomy (LRP) was reported. A total of 42 patients were randomly selected and enrolled in this study. A standard LRP was performed in 21 patients (group 1), whereas a novel, modified apical dissection of the prostate in LRP was performed in another 21 patients (group 2). Surgical data, total operative time, VUA time, extravasation rate, catheterisation time, occurrence of anastomotic strictures, and the early and late continence rates were analysed statistically. No differences in clinical or pathological characteristics were determined between the two groups. The total operative time, VUA time, blood loss and catheterisation time were lower in group 2, which received the novel, modified technique compared with group 1, which received the standard technique to dissect the apex of the prostate (P < 0.01 for each variable). Regarding the extravasation rate and the occurrence of anastomotic strictures, no significant differences were found between the two groups (P > 0.05 for each). After catheter removal, a statistically significant difference in the continence rates was present at 3 and 30 days post operation in the two groups (P < 0.01, respectively). At 90 days post operation, the difference, although still present, was no longer statistically significant (P > 0.05). The novel, modified apical dissection of the prostate facilitates the VUA and significantly improves the efficacy of the procedure and early restoration of continence.

A comparative study of clinical value of single B-mode ultrasound guidance and B-mode combined with color doppler ultrasound guidance in mini-invasive percutaneous nephrolithotomy to decrease hemorrhagic complications.

OBJECTIVES: To compare the clinical value of single B-mode ultrasonography and B-mode combined with color Doppler ultrasonography in the guidance of mini-invasive percutaneous nephrolithotomy (m-PCNL) to decrease the incidence of hemorrhagic complications. METHODS: A total of 297 patients with renal stones who had undergone m-PCNL were retrospectively categorized into 2 groups. Group 1 (187 patients) underwent m-PCNL with single B-mode ultrasound guidance and group 2 (110 patients) underwent m-PCNL with combined B-mode and color Doppler ultrasound guidance. The clinical characteristics of the patients, intraoperative and postoperative characteristics, complications, especially hemorrhagic complications, and blood transfusion rate were recorded and compared. RESULTS: No statistically significant differences in age, height, weight, stone burden, operative time, stone-free rate, or length of postoperative hospital stay were found between the 2 groups. In group 2, a statistically significant decrease in the transfusion rate was found compared with group 1 (P <.05). In group 1, 5 patients (2.6%) required a blood transfusion, 2 (1.1%) developed a renal arteriovenous fistula and required embolotherapy, 2 (1.1%) developed hemorrhage and required embolotherapy after surgery, 16 (8.6%) developed capillary hemorrhage during surgery but had no hemorrhage postoperatively. However, no serious hemorrhagic complications were found in group 2. Only 3 patients (2.7%) developed capillary hemorrhage during surgery, and no hemorrhage occurred postoperatively. CONCLUSIONS: Using combined B-mode and color Doppler ultrasound guidance during in m-PCNL resulted in the real-time detection and avoidance of the renal blood vessels during puncture and decreased the incidence of hemorrhagic complications, especially in the patients with a solitary and compensative kidney.