Editor's Note: The 2024 Annual Meeting of the Urological Surgeons Branch of the Chinese Medical Association (CUDA) was held in Xi'an from August 8 to 11, 2024. The conference, organized by the Chinese Medical Association and the CUDA Urological Surgeons Branch, was hosted by the Air Force Medical University Xijing Hospital and co-organized by the Shaanxi Provincial Medical Association Urological Surgeons Branch. The event showcased the latest achievements in urology from a broad and diverse perspective. During the conference, Urology Frontier interviewed the Honorary Chairman of the conference, Dr. Guohua Zeng from The First Affiliated Hospital of Guangzhou Medical University, who shared insights on the remarkable achievements of minimally invasive urological stone surgery in China, the development trends of percutaneous nephrolithotomy (PCNL), and valuable suggestions for improving the treatment and quality of life for patients with urinary stones.
1. Urology Frontier: Could you discuss the current state of minimally invasive surgery for urinary stones in China and its unique characteristics?
Dr. Guohua Zeng: The incidence of urinary stones is very high in China, and many doctors are engaged in minimally invasive treatments for these conditions. The main minimally invasive treatment methods include extracorporeal shock wave lithotripsy (ESWL), ureteroscopy (flexible and rigid), percutaneous nephrolithotomy (PCNL), robot-assisted laparoscopic surgery, and traditional laparoscopic surgery. The first three are the most common, while the others need careful consideration regarding their suitability for specific patient groups.
China holds a prominent position in the global field of minimally invasive urological stone surgery, with promising development trends. In 2012, Professor Ye Zhangqun from Tongji Hospital of Huazhong University of Science and Technology, Professor Kemal Sarica from the Department of Urology at Yeditepe University in Istanbul, and I co-founded the International Alliance of Urolithiasis (IAU). Over the past twelve years, the IAU has grown into an international platform for urolithiasis, with over 1,000 members from 117 countries and regions. This platform helps Chinese scholars share their voices internationally and allows them to learn about the latest global developments.
Chinese scholars have made outstanding contributions to the treatment of urinary stones and the development of surgical instruments, setting trends that international peers follow. For example, the super-mini percutaneous nephrolithotomy (SMP) technique we pioneered has been adopted by over 300 hospitals in 59 countries. The 7.5Fr (approximately 2.5mm) flexible ureteroscope we developed is globally leading and has received FDA approval, entering the international market. Professor Li Jianxin’s Needle-perc® needle nephroscope (4.2 Fr) is also highly advanced and represents the cutting edge of the field.
In summary, China has significant advantages in minimally invasive surgery for urinary stones. However, it is essential to note that we still lag behind developed Western countries in prevention and basic research. I believe that with continued efforts, this gap will gradually close.
2. Urology Frontier: In your presentation titled “In the Era of Rising Flexible Ureteroscopy, How Far Can PCNL Go?” what are your thoughts on the future opportunities for PCNL?
Dr. Guohua Zeng: The biggest advantage of flexible ureteroscopy is its natural orifice approach, which allows for quick patient recovery. However, the natural orifice provides limited space, and although an extraction sheath can be used to remove stones, its maximum diameter is only 4mm. This limits its optimal indication to stones with a diameter of ≤3cm. For stones larger than 3cm, such as staghorn or infectious stones, PCNL is still necessary.
The reason why some clinicians may be hesitant to use PCNL is its longer learning curve and higher technical demands compared to flexible ureteroscopy. The key challenges of PCNL are achieving precise puncture and efficient stone removal. Currently, our team, in collaboration with Academician Zhang Xu from the General Hospital of the People’s Liberation Army, is developing a new puncture robot. This robot uses skin markings and intelligent 3D modeling navigation to achieve precise puncture access, solving the issue of accuracy in PCNL puncture. Additionally, we are developing a stone removal robot. After successful puncture, the robot’s extraction sheath can quickly remove stones. Combining these two technologies addresses the technical challenges of PCNL, both mentally and physically. In short, PCNL has unique indications, and with the advancement and promotion of new technologies, it still has broad application prospects and will continue to coexist with flexible ureteroscopy and other treatment methods.
3. Urology Frontier: What strategies can further improve patient quality of life in the future development of kidney stone surgery?
Dr. Guohua Zeng: Enhancing the quality of life for stone patients is crucial and can be achieved through the following three aspects:
- Pain Management: The pain caused by stones can significantly affect a patient’s daily life, so addressing pain is essential. Early detection and treatment of stones can effectively prevent pain.
- Residual Stones: Residual stones can lower a patient’s quality of life. Clinically, we use various combined methods to clear stones as thoroughly as possible, such as combining rigid and flexible ureteroscopy and using extraction sheaths to remove residual stones.
- Stone Recurrence: Preventing stone recurrence is critical. Many surgeons focus solely on whether the stones are thoroughly removed during surgery and overlook the issue of recurrence. To prevent recurrence, it is essential to remove all stones during surgery and, as Professor Ye Zhangqun suggested, perform pathological analysis of the stone composition postoperatively. Based on the analysis, we can use medications or lifestyle interventions to prevent recurrence.
In summary, we must treat patients early to alleviate symptoms, clear stones as thoroughly as possible to avoid residual stone-related pain or recurrence, and implement preventive measures to delay or avoid recurrence. This comprehensive approach will effectively enhance patients’ treatment experiences and overall quality of life.
Dr. Guohua Zeng
- Second-Level Professor, Chief Physician, and Doctoral Supervisor
- Vice President, First Affiliated Hospital of Guangzhou Medical University
- Leader of the Urology Discipline, Guangzhou Medical University
- Director, Guangdong Provincial Key Laboratory of Urology
- President and Secretary-General, International Alliance of Urolithiasis (IAU)
- Vice President, Urology Branch, Chinese Medical Doctor Association
- Vice President, Andrology and Sexual Medicine Branch, Chinese Medical Doctor Association
- Standing Committee Member and Deputy Leader of the Stone Group, Urology Branch, Chinese Medical Association
- Former Chairman and Leader of the Stone Group, Urology Branch, Guangdong Medical Association
- Editorial Board Member, BJU International, Urolithiasis, and Chinese Journal of Urology
- International Member, Stone Group, European Association of Urology (EAU)
- Standing Committee Member, Fellowship Committee, Endourology Society
- Committee Member, R.O.C.K. Society of Urolithiasis
- His research focuses on minimally invasive treatment and the etiology of urinary stones.
- Recipient of 11 science and technology awards, including the Second Prize for Science and Technology Progress from the Ministry of Education and the First Prize for Science and Technology Progress in Guangdong Province.
- Winner of the “Wu Jieping Urology Medical Award,” the highest honor in urology, and the “Diamond Award” for excellence in the field of urolithiasis from the Urology Branch of the Chinese Medical Association.
- The only invited surgeon from Asia to perform surgery at the 4th and 5th European Urology Stone Congress.
