Medium-term follow-up of clinically insignificant residual fragments after minimally invasive percutaneous nephrolithotomy lithotripsy / 中国医师进修杂志

Objective To discuss the medium-term follow-up of clinically insignificant residual fragments (CIRF) after minimally invasive percutaneous nephrolithotomy lithotripsy (MPCNL).Methods The clinical data of 72 patients with CIRF medium-term follow-up were analyzed retrospectively.Results Seventy-two patients with CIRF.The anatomical distribution of CIRF was 10 at upper pole,15 at middle,35 at lower,10 at renal ureteropelvie junction and 2 at upper and lower pole.Stone analysis showed that 41 cases of calcium oxalate calculi,16 of calcium oxalate calculi mixed with carbonate calculi,3 calcium oxalate calculi mixed with uric acid,4 calcium oxalate calculi mixed with struvite stone,3 struvite stone,2 uric acid stone and 3 carbonate apatite mixed with struvite stone.Fifteen cases had clinical symptoms,including 2 renal colic pain,8 hematuria,5 lower urinary tract symptoms,4 cases CIRF located in upper pole,1 case in middle pole,4 cases in lower pole,6 cases in ureteropelvic junction,the incidence of clinical symptoms in ureteropelvic junction was significantly higher than that in other locations (6/10 vs.4/12,1/15,4/37,P ＜0.05).Eight cases required surgical procedure,5 cases underwent extracorporeal shock wave lithotripsy,3 cases with ureteral CIRF were performed with ureteroscopic lithotripsy.CIRF were clear after surgery,7 patients with ureteral CIRF had renal colic pains.The stones were excluded after spasmolytic analgesic treatments.Conclusions CIRF can be located variously in the kidney and ureter.Most CIRF are calcium oxalate calculi and locate in the lower pole.Patients with the history of previous open surgery or extracorporeal shock wave lithotripsy are more likely to get CIRF.Medium-term follow-up of CIRF reveals that CIRF located in the renal ureteropelvis junction are more likely to have clinical symptoms.

Are Clinically Insignificant Prostate Cancers Really Insignificant among Korean Men?

PURPOSE: We aimed to determine whether 12 core-extended biopsies of the prostate could predict insignificant prostate cancer (IPCa) in Koreans reliably enough to recommend active surveillance. MATERIALS AND METHODS: Two hundred and ninety-seven patients who underwent radical prostatectomy after 12 core-extended prostate biopsies were retrospectively reviewed. 38 cases (12.8%) were shown to be IPCa. RESULTS: The average age was 65.2 years, serum PSA was 5.49 ng/dL, and the PSA density was 0.11. The Gleason scores (GS) were 6 (3+3) in 31, 5 (3+2) in 4, and 4 (2+2) in 3. After radical prostatectomy, higher GS was given in 16 (42.1%), whereas lower GS was given in 1 case (2.6%), as compared with the GS obtained from biopsy. 11 (28.9%) had GS of 7 (3+4) and 5 (13.2%) had GS of 7 (4+3). 6 in GS 7 (4+3) and 1 in GS 7 (3+4) showed prostate capsule invasion and 1 in GS 7 (4+3) had seminal vesicle invasion. Prostate capsule invasion was observed in 1 with GS 6 (3+3). The rate of inaccuracy of the contemporary Epstein criteria was 42.1%. Only PSA density was a reliable indicator of clinically IPCa (odds ratio=1.384, 95% CI, 1.103 to 2.091). CONCLUSION: Diagnosis of IPCa from a prostate biopsy underestimated the true nature of prostate cancer in as many as 42.1% of Koreans.

Medium-term follow-up of clinically insignificant residual fragments after minimally invasive percutaneous nephrolithotomy / 中华泌尿外科杂志

Objective To discuss the outcomes of the clinically insignificant residual fragments after minimally invasive percutaneous nephrolithotomy. Methods 75 patients (11％) with CIRF among 655 who underwent initial MPCNL from January 2008 to December 2010 were diagnosed by CT scan.Clinical data of 68 patients (39 male and 29 female) were analyzed retrospectively.Previous open surgery hadbeen performed in 13 and ESWL in 20 cases.The median residual fragment size was 1.8 mm.The anatomical distribution of CIRF was 9 at upper pole,14 at middle,34 at lower,9 at renal ureteropelvic junction and 2 at upper and lower pole.Stone analysis showed 40 cases of calcium oxalate calculi,15 of calcium oxalate calculi mixed with carbonate calculi,2 calcium oxalate calculi mixed with uric acid,3 calcium oxalate calculi mixed with struuvite stone,3 struuvite stone,2 uric acid stone and 3 carbonate apatite mixed with struvite stone.Mean follow up was 23 months (12-36).Follow-up consisted of physical examination,serum routine,urine routine and CT imaging. Results 14(21％) patients (3 upper pole,1 middle pole,4 lower pole and 6 ureteropelvic junction) had symptomatic episodes,including 9 hematuria,2 renal colic pain,5 lower urinary tract symptoms,12 with size of CIRF ＞ 4 rmm.8 patients required surgical procedures.5 patients (1 middle,2 upper pole and 2 renal pelvis) underwent ESWL.3 patients with ureteral CIRF were performed ureteroscopic lithotripsy.The CIRF were clear after surgeries.4 paticnts with CIRF ＞ 4 mm did not have symptoms.These patients were recommended to conservational treatments.2 patients with ureteral CIRF had renal colic pains.The stones were excluded after spasmolytic analgesic treatments.27％ (3/11)CIRF located in upper pole had symptom,compared with 4％ (1/14) in middle pole,11％ (4/36) in lower pole and 67％ (6/9) in ureteropelvic junction. Conclusions CIRF can be located variously in the kidney and ureter.Most CIRF are calcium oxalate calculi and locate in the lower pole.Patients with the history of previous open surgery or SWL are more likely to get CIRF.Medium-term follow-up of CIRF revealed that CIRF located in the renal ureteropelvis junction are more likely to have clinical symptoms.

Fate of clinically insignificant residual fragment(CIRF) after extracorporeal shock wave lithotripsy with EDAP-LT01 lithotriptor / 대한비뇨기과학회지

The stone-free rate of 248 cases of CIRF was 32.7% by 1 month, 73.0% by 3 months and 92.7% by 6 months of follow-up. The stone-free rate decreased but not remarkably in accordance with the. increment of the calyceal dilatation (92.9%, 94.9%, 85.7 % and 83.3 % for no, mild, moderate and severe dilatation, respectively, by 6 months of follow-up). The clearance of the CIRF was not influenced by the location of CIRF, the pelviocalyceal angle, the infundibular length and number of the lower calices. Of 16 patients who had residual stone fragments by 6 months and underwent an additional session of ESWL, 12 became stone-free by another 6 months of follow-up. Therefore, it is desirable to wait for clearance of CIRF for at least 6 months before offering further treatment regardless of CIRF location and anatomical variation of the calices containing CIRF. Repeated ESWL even for stone fragments of 3-tmm in diameter found initially 1 month after the last session or ESWL might promote clearance of the CIRF, and additional ESWL for persistent CIRF could be an appropriate adjunctive measure.