Endourologic management of forgotten encrusted ureteral stents: can ureteroscopic lithotripsy be avoided?

We present endourologic management strategies and tricks to minimize instrumentation and complications in long-indwelling encrusted stents. Seventeen patients presented with 19 retained ureteral stents (median indwelling time 3.0 y; 0.25 to 17 y). Investigations included x-ray, ultrasound, noncontrast computed tomography, excretory urography, magnetic resonance imaging, Tc diethylenetriaminepenta-acetic acid scan, and retrograde ureterography. Incrustation was present in all stents, encrustation 16, stone formation 11, and spontaneous fragmentation 3. All patients had gaping of ureteric orifices and dilated capacious ureters with no stent impaction. Management included extracorporeal shock wave lithotripsy (2), simple pull under fluoroscopy cystoscopically (2) and ureteroscopically (2), cystolithotripsy (10), percutaneous nephrolithotripsy (6), nephrectomy (2), and no intervention (2). In 3 patients with large encrustation burden, tubular encrustation in ureteral segment of stent could be removed intact without lithotripsy. To conclude, encrusted ureteral stents can be successfully managed using endourologic interventions. Owing to capacious ureter and nonimpacted stent, a careful attempt of pulling can be made under fluoroscopic guidance to minimize the time of ureteroscopic lithotripsy and complications thereof.

Lactose intolerance in prostate cancer patients: incidence and associated factors.

OBJECTIVE: Osteoporosis is common in prostate cancer (CaP) patients both before and after institution of androgen deprivation therapy and is associated with significant morbidity. Lactose intolerance (LI) can affect bone mass but has not been studied in this group of patients. The objective of this study was to compare the incidence of LI in CaP patients with that in the general population and to identify factors affecting lactose intolerance in CaP patients. MATERIAL AND METHODS: Fifty-five men with CaP planned for bilateral orchidectomy were enrolled in the study and their baseline characteristics including age, weight, height, body mass index (BMI), prostate-specific antigen, serum calcium profile, lactose tolerance status, physical activity, alcohol intake and smoking, bone mineral density and calcium intake were registered. The data on lactose tolerance in these patients were compared with those of 81 age-matched controls (data taken from the available database). RESULTS: The incidence of LI in CaP patients was significantly less than that in the control group (36.2% and 58.3%, respectively, p = 0.027). A significantly greater number of CaP patients in the lactose-tolerant group had a calcium intake of >1500 mg/day (p = 0.03) and that of milk >500 ml/day (p = 0.05) than those in the intolerant group. Age >70 years, BMI <25 kg/m2, height >163 cm, lower physical activity and co-abuse of alcohol and smoking significantly correlated with the presence of LI (p < or = 0.05). Patients with serum calcium <9 mg/dl had higher fasting breath H2 levels and a higher proportion had a BMI >25 kg/m2 and weight >65 kg. CONCLUSIONS: The incidence of LI in CaP patients is less than that in the general population despite a higher incidence of osteoporosis, indicating a complex etiology of CaP-related osteoporosis. Certain physical characteristics and personal habits are important in determining lactose-tolerant status.