application of KUB for detecting of submucosal ureteral stones

The accurate diagnosis of submucosal ureteral stones in order to choose a proper and less complicative method of treatment is of significant importance. The use of KUB to detect submucosal ureteral stones has been studied in this research. This prospective study has been carried out on 33 patients [23 males and 10 females] with lower ureteral stone [17 cases in the right ureter and 16 in the left] located under iscial spine as was indicated in their KUB. The distance from the lower end of stone to the midline of sacrum was measured per millimeter using KUB. All patients underwent ureteroscopy, and accordingly those with submucosal ureteral stones were distinguished. The correlation between the distance of the lower end of stone from the middle line of sacrum and the existence of submucosal ureteral stone was analyzed. Nineteen out of 33 studied patients had submucosal ureteral stones. The average distance between the peak of stone and the middle line of sacrum in patients with submucosal ureteral stone was 9.7 mm with an accuracy of 1.4 mm, a confidence interval 95% and standard deviation of 3.1 mm. Accordingly, if the distance of stone from the middle line of sacrum is lower than 13.7 mm, in 90% of cases the stone will be submucosal. In patients with lower ureteral stone, the KUB of whom indicates a stone under iscial spine, if the distance of the peak of stone from the midline of sacrum was lower than 15 mm, the stone could most likely be submucousal, a point, which should be considered during treatment. In such cases the intravesical approach should be considered intraoperatively and preparation for submucosal ureteral incision must be provided. This method would be useful in stone removal, if the classic ureteroscopy was not successful

Effect of smoking on prognostic factors of transitional cell carcinoma of the bladder

This study was conducted to evaluate the effects of smoking on the clinical characteristics and growth trend of transitional cell carcinoma [TCC] of the bladder. In a retrospective case-control study from February 2000 to March 2003, patients with TCC of bladder, referred to our clinic, were selected and divided into high-grade and low-grade groups. Groups were matched for other known risk factors and the effect of smoking on size, number, and presenting grade of TCC in each group was evaluated. A total of 185 patients, with a mean age of 65.1 +/- 14.0 year, were included in this study, of whom 36 were females and 149 were males [male to female ratio of 4.1 to 1]. Eighty-three patients were smokers [44.9%] with a mean 20.01 +/- 11.09 packyear [range 0.75 to 60] smoking history. History of smoking was positive in 36.1% of the patients with low-grade tumors; whereas, 90% of the patients with high-grade tumors were smokers [P=0.000, OR=15.9, 95% CI: 6.7-36.9]. There was a statistically significant correlation between the history of smoking and size and number of tumoral lesions [P=0.000, P=0.000, respectively]. Positive history of smoking was also associated with higher grades of tumor in both men and women [OR=12.8 and 8.8, respectively]. This study showed that smoking not only induces bladder cancer, but also, once it develops, it can increase the grade of tumor, resulting in worse prognosis. Thus, smoking cessation might favorably alter the course of bladder cancer