ABSTRACT
Background: Stone size is a key factor in the determination of the success of treatment modalities. Recently, there has been a great advancement in technology for minimally invasive management of urinary stones such as percutaneous nephrolithotomy, ureteroscopy, shockwave lithotripsy, and retrograde internal Surgery
Aim of the Study: to assess and compare the efficacy of retrograde intrarenal surgery [RIRS] in the treatment of kidney stones greater than 2 cm versus percutaneous nephrolithotomy [PCNL]
Patients and methods: A retrospective analysis was carried out for a total of 118 patients, of which 46 patients underwent RIRS while 72 patients underwent PCNL between May 2013 and May 2017
Results: The mean duration of operation was 96.39 +/- 41.11 min in the RIRS group and 69.51 +/- 19.3 min in the PCNL group [p<0.001]. Hospital stay was significantly shorter in the RIRS group [1.32 +/- 0.6 vs. 4.19 +/- 1.9 days] in the RIRS and PCNL groups respectively [p<0.001]. Stone-free rates after one session were 67.4% and 90.3% of the RIRS and PCNL groups, respectively. Blood transfusions were required in two patients in the PCNL group. Complication rates were generally higher in the PCNL group
Conclusion: The present study concluded that RIRS can be a successful substitute to PCNL in the treatment of kidney stones with a diameter of 2-4 cm particularly in patients with comorbidities
ABSTRACT
Purpose: To Compare tomosynthesis to mammography, ultrasound, MRI, and histology for the detection and staging of BI-RADS 4-5 anomalies, as a function of breast composition, histology, size, and lesion location
Materials and methods: 25 patients underwent tomosynthesis, MRI, mammography, and ultrasound. The diagnostic accuracy of the different examinations was compared
Results: The sensitivities for detection were as follows: 92.7% for MRI, 80.5% for ultrasound, 75.6% for tomosynthesis, and 61% for mammography. Tomosynthesis improves the sensitivity of mammography [P= 0.0001], but not the specificity. The detection of multifocality and multicentricity was improved, but not significantly. Tomosynthesis identified more lesions than mammography in 10% of cases and improved lesion staging irrespective of the density, but was still inferior to MRI. The detection of ductal neoplasia was superior with tomosynthesis Compared to mammography [P = 0.016], but this was not the case with lobular cancer. The visualization of masses was improved with tomosynthesis [P = 0.00012], but not with microcalcifications. Tomosynthesis was capable of differentiating lesions of all sizes, but the smaller lesions were easier to see. Lesion sizes measured with tomosynthesis, excluding the spicules, concurred with histological dimensions. Spicules lead to an overestimation of the size
Conclusion: In our series, tomosynthesis found more lesions than mammography in 10% of patients, resulting in an adaption of the surgical plan