Transperitoneal laparoscopic simple nephrectomy for giant hydronephrosis: Tips and tricks to make it easier.

PURPOSE: We report our experience with transperitoneal laparoscopic nephrectomy (LN) for giant hydronephrosis (GH) and compare the outcome data with open nephrectomy (ON). PATIENTS AND METHODS: The retrospective data of 88 patients (52 males and 36 females) who underwent LN or ON for treatment of GH in the period between October 2015 and December 2019 were investigated. LN was performed in 38 patients, while 50 patients underwent ON. We compared the two groups for success, operative time, and intraoperative and postoperative complications. RESULTS: The mean age of the patients in the LN group was 45.8 ± 11.4 years, and it was 44.7 ± 10.8 years in the ON group. The mean operative time in the LN group was statistically significantly longer when compared with the ON group195 ± 18 min versus 127 ± 22 min (p = 0.01).The estimated blood loss was significantly greater in the ON group (p = 0.01). However, no patients required blood transfusions in either group. The visual analog pain (VAP) scores were significantly higher on both day 1 and day 2 in the ON group 3.6 ± 0.9 and 2 ± 0.7 versus 2.7 ± 0.6 and 1.4 ± 0.5 in LN group, (p = 0.01). CONCLUSION: LN for GH is feasible, safe, and efficacious. Compared to open surgery, the laparoscopic approach resulted in significantly shorter hospital stays, decreased morbidity, and quicker recovery. Some tips and tricks could help to do it in an easier way and reduce the operative time.

The role of mirabegron in relieving double-J stent-related discomfort: a randomized controlled clinical trial.

INTRODUCTION: The aim of this study was to investigate the effect of 50 mg mirabegron once daily in relieving ureteral double-J (DJ) stent-related discomfort after ureteroscopy (URS) or retrograde intrarenal surgery (RIRS). MATERIAL AND METHODS: A total of 210 patients who underwent DJ ureteral stent insertion after URS or RIRS were randomized 1:1 to receive either no treatment (Group B) or mirabegron 50 mg once daily (Group A) during the stenting period. At time of stent removal, all patients were evaluated for stent-related symptoms using the Arabic translated and validated ureteral stent symptom questionnaire (USSQ). The severity of stent-related symptoms (SRS) was compared between the two groups. RESULTS: The mean age was 46.6 ±8.2 years in Group A and 44.7 ±9.4 (26-64) years in the control group (p = 0.13). The stone characteristics, stent size, and position were similar in both groups. Compared to the control group, the mirabegron group had significantly lower daytime frequency, nocturia and urgency (p = 0.028, p = 0.008 and p = 0.012, respectively). As for stent-related pain, Group A had significantly less flank and abdominal pain (p = 0.007 and p = 0.001, respectively). The mirabegron versus control group showed significant difference in mean analgesics use and quality of life (QoL) scores during the stenting period (p = 0.005 and p = 0.003, respectively). Three patients (2.9%) in Group A encountered minor adverse effects (two experienced dry mouth and one presented with constipation). CONCLUSIONS: For patients with indwelling DJ stent, postoperative mirabegron 50 mg use was effective and well-tolerated for the treatment of lower urinary tract symptoms and stent-related pain.

Results of two-stage transverse preputial island flap urethroplasty for proximal hypospadias with chordee that mandate division of the urethral plate.

INTRODUCTION: Reconstruction of proximal hypospadias with chordee remains a difficult task. Our work aims to evaluate the role of two-stage transverse preputial island flap urethroplasty for repair of proximal hypospadias with chordee. MATERIAL AND METHODS: This is a retrospective study including 57 children who underwent two-stage transverse preputial island flap urethroplasty. Glans meatus shaft (GMS) score was applied to 24 cases. Patient's characteristics, operative details and complications were assessed. Hypospadias objective scoring evaluation was used for postoperative assessment. RESULTS: The mean age at the first stage operation was 23.6 months (9-84); the mean time interval between the first and second stage operations was 8.1 months (6-12) and the mean follow-up duration was 52.1 months (24-96). Urethral meatus was proximal penile in 18 patients, penoscrotal in 24 and scrotal in 15. The mean degree of ventral curvature (VC) was 51.5° (30-90). After the second stage operation, postoperative complications occurred in 16 (28.1%) patients with urethrocutaneous fistula in 6 (10.5%) cases, diverticulum in 3 (5.3%), glans dehiscence in 5 (8.8%) and meatal stenosis in 2 (3.5%). All cases of glans dehiscence occurred in severe hypospadias and small glans. Moderate GMS score was present in 10 (41.7%) cases and severe GMS in 14 (58.3%). Complications occurred in 7 (29.1%) patients with 5 (20.8%) with a severe GMS score and 2 (8.3%) with a moderate GMS score. The hypospadias objective scoring evaluation showed satisfactory results, with 39 (68.4%) patients achieving a score of 16 points. CONCLUSIONS: Two-stage transverse preputial flap is a good choice for repair of proximal hypospadias with an acceptable complication rate of 28.1%.

Contralateral Coupling During Extracorporeal Shockwave Lithotripsy for Stones in Ectopic Kidney: Is It Feasible?

Purpose: Extracorporeal shockwave lithotripsy (SWL) results in a lower stone-free rate (SFR) for ectopic kidneys when using the standard technique, directing the shock wave from the same side of the stone; however, this may not be the optimal approach when the ectopic kidney is located more medial and anterior than the normally positioned kidney. Thus, contralateral coupling where waves come from the opposite direction may result in a better outcome. We tested the feasibility and outcome of contralateral coupling during SWL for stone in ectopic kidney. Materials and Methods: We prospectively recruited 20 patients with simple renal ectopia, who presented with renal stones that were amenable for SWL in the period between 2014 and 2018 at outpatient clinic of urology department, Minia University. Patients received SWL in Private Nile SWL Center were included to benefit from the ability of the electromagnetic SWL lithotripter. We did SWL in a supine position, and then contralateral coupling was performed from the opposite side of the affected kidney, rather than using the standard ipsilateral coupling approach. The SFR and various pre-, intra-, and postprocedural SWL variables were assessed, including stone characteristics, body habitus, shock wave numbers, and auxiliary measures. Count and percentages were calculated. Results: The mean stone radius was 14.7 mm with a mean S.T.O.N.E. (size, topography, obstructions, number of stones, and evaluation of HUs) of 9.6 points. Effective SWL was achieved in 80% of cases, 65% of them were stone free with effective single SWL session in 56% of cases. Hematuria, infection, and obstruction occurred in 50%, 20%, and 15% cases, respectively. One case required ureteral stent insertion. Conclusions: SWL applied through contralateral coupling is feasible, with comparable safety profile to the standard ipsilateral approach. Better SFR was achieved with the contralateral approach, in fewer sessions. However, the recruitment of more cases is necessary.

Prevention of stone retropulsion during ureteroscopy: Limitations in resources invites revival of old techniques.

OBJECTIVE: To compare a modified technique using the Dormia basket vs Stone Cone for stone entrapment to avoid proximal stone migration during ureteroscopic pneumatic lithotripsy of ureteric stones. PATIENTS AND METHODS: Our study included all patients with ureteric stones of <15 mm who underwent ureteroscopic pneumatic lithotripsy from January 2015 to September 2018. The study had two arms that were conducted over two consecutive periods; the first included 72 patients in whom we used the Stone Cone (Group 1) and the second included 86 patients in whom we started to use a Dormia basket with a modification (Group 2) to guard against proximal stone migration. RESULTS: Both groups were comparable for gender, age, and stone characteristics. Lower ureteric stones were the most prevalent as they represented 62.5% and 60.5% in groups 1 and 2, respectively; while upper ureteric stones were respectively found in 16.7% and 17.4%. Chemical stone analysis revealed that calcium oxalate stones were most predominant accounting for 51.3% and 51.1% in groups 1 and 2, respectively. Most of the stones were radio-opaque stones representing 57% and 58.1% in groups 1 and 2, respectively. There was a significant difference in operative time, with a mean (SD) operative time was 50.9 (11.2) in Group 1 vs 58.3 (12.4) min in Group 2 (P < 0.001). The success rate, defined as no retropulsion of stone fragments, was 97.7% in Group 2 vs 91.7% in Group 1 (P < 0.01). Complications were minor and comparable between the groups. There was no difference in hospital stay between the groups, but the cost assessment favoured Group 2. CONCLUSION: We found that our modified-basket stone entrapment technique compared favourably with the Stone Cone to guard against stone retropulsion during ureteroscopic pneumatic lithotripsy. Our modification to the basket was found to be feasible, efficient, safe, reproducible and cost-effective in preventing proximal stone migration. This procedure is particularly suitable in cost-limited environments.

Prospective comparative study between the effect of CIDEX® OPA and STERRAD NX on the durability of digital flexible ureteroscope.

PURPOSE: We compared the effect of chemical disinfection (CIDEX® OPA) and low-temperature hydrogen peroxide gas plasma (STERRAD NX) on two brand new digital flexible ureteroscope (DFU) (Flex-Xc) using subjective and objective parameters. METHODS: Over 11-month period, all flexible ureteroscopic procedures that fulfill the inclusion criteria were done by two brand new flexible ureteroscopes and were prospectively evaluated. Intraoperative data included total operative time, laser power and duration, stone criteria and subjective evaluation of the procedure as well as visibility and maneuverability scores were reported. The end point of the study was when the scope was deemed by the surgeon as unable to perform the procedure; when leak test is positive. RESULTS: A total of 88 patients were randomized either for the first flexible ureteroscope disinfected using Cidex® OPA (n = 59, 67%) or second ureteroscope sterilized with Sterrad NX (n = 29, 33%). Intraoperative, the first DFU was significantly used with a total operative time of approximately 49 h compared to the second one (p < 0.001). In the same context, laser power parameters were significantly different among the two groups (p = 0.003). The subjective evaluation of the procedure, maneuverability, visibility scores, laser duration, stone burden and post-operative infection rate were statistically insignificant between both groups. At the end point of the study, the deflection in up and downward directions for both DFU were measured. CONCLUSIONS: The durability and longevity of the DFU is strongly related to the sterilization method. Our findings suggest that CIDEX® OPA should prioritize Sterrad in sterilization of DFU.

Buccal mucosal graft versus penile skin flap urethroplasty for long segment penile urethral stricture: a prospective randomized study.

INTRODUCTION: The aim of this study was to analyze the outcomes of dorsolateral onlay buccal mucosal graft (BMG) and ventral onlay local penile skin flap (LPF) urethroplasty in the management of long segment penile urethral stricture (PUS). MATERIAL AND METHODS: Through a prospective study conducted between October 2014 and May 2018, 84 patients with long segment PUS were randomly assigned to receive either dorsolateral onlay BMG (Group 1 which included 42 patients) or ventral onlay PSF urethroplasty (Group 2 which included 42 patients). The success rate and surgical outcomes were compared in both groups. RESULTS: The success rate was 92.9% in Group 1 and 85.7% in Group 2 (p = 0.5). Postoperative short segment urethral stricture at the site of proximal anastomosis was reported in 3 patients in Group 1. Six patients in Group 2 were considered as a treatment failure, 3 of them due to recurrence of long segment urethral stricture after 6 months, and 3 patients developed ring urethral stricture at the site of proximal anastomosis managed by direct vision internal urethrotomy. CONCLUSIONS: On an intermediate term follow-up, dorsolateral onlay BMG and ventral onlay LPF provide similar success rates in penile urethroplasty, with essentially comparable postoperative morbidity. However, further studies with bigger sample sizes and longer follow-up periods may be required to determine subtle differences between both techniques.

Outcome of early experience of Miniperc technique in pediatric age group.

BACKGROUND: The aim of this study is to report our experience with the Miniperc technique for treatment of renal stone in pediatric age group. MATERIALS AND METHODS: From August 2012 to January 2015, 34 patients aged <15 years with renal stones <3 cm underwent Miniperc technique were included in our study. The procedure was done through 14 Fr sheath using 8/9.8 Fr semi-rigid ureteroscope, holmium laser, and pneumatic lithotriptor for stone fragmentation. Stone-free rate (SFR), operative time, hospital stay, and complication rate were evaluated. RESULTS: A total of 34 Miniperc techniques were performed on children with a mean age of 8.8 ± 3.7 years. Stone size varied from 18 to 30 mm (mean 23 mm). Mean operative time was 50 min. The mean hospital stay was 48±12 hours. The overall SFR was 82.4% which increased after secondary procedures to 94%. Two postoperative complications recorded in the form of sepsis and bleeding that required no blood transfusion. CONCLUSION: Our initial experience concluded that Miniperc technique is a safe and effective treatment option for renal stones in pediatric population.

Initial laparoscopy and optimized approach for unilateral nonpalpable testis: review of 8-year single-center experience.

PURPOSE: We evaluated the role of initial laparoscopy and optimized approach in cases of unilateral nonpalpable testis. METHODS: Seventy-four patients with nonpalpable testes were presented. We excluded 9 patients, with palpable testes under anesthesia. Laparoscopy was offered to 65 patients. Contralateral testis hypertrophy with length ≥ 1.8 cm was confirmed in 47 patients. Ultrasound results were available for 35 patients. RESULTS: Age ranged from 1 to 10 years. Of 65 nonpalpable testes, right side comprised 23 (35.4%) and the left 42 (64.6%). Laparoscopy revealed intra-abdominal testis in 18 patients (27.7%), blind-ending vessels and vas in 8 (12.3%), and vas and vessels traversing the internal ring in 39 (60%). Treatment of intra-abdominal testes included Fowler-Stephens orchiopexy in 7 patients, laparoscopic orchiopexy in 9, and laparoscopic orchiectomy in 2. In 8 patients with blind-ending vas and vessels, laparoscopy was terminated. In 39 patients with vas and vessels traversing the internal ring, scrotal exploration was performed in 36 patients with closed internal ring and inguinal exploration in 3 with open internal ring. Vanished testes were present in 43/47(91.5%) of patients with contralateral testis hypertrophy ≥ 1.8 cm. Ultrasound detected the presence of a testis in only 4/11 (36.3%) of patients, although it could not identify vanished testis. CONCLUSIONS: Initial laparoscopy should be retained as one of the standard treatment for nonpalpable testis. It was the only required modality in 26 patients (40%) and optimized further treatment in 39 patients (60%) by evaluation of the condition of the internal ring.

Retrospective comparative study of rigid and flexible ureteroscopy for treatment of proximal ureteral stones

ABSTRACT Background: We analyzed the outcome and complications of rigid (R-URS) and flexible (F-URS) ureteroscopic lithotripsy for treatment of proximal ureteric stone (PUS). Subjects and methods: Retrospective data of 135 patients (93 males and 42 females) submitted to R-URS and F-URS for treatment of PUS in the period between July 2013 and January 2015 were investigated. (R-URS, group 1) was performed in 72 patients while 63 patients underwent (F-URS, group 2).We compared the 2 groups for success, stone characteristics, operative time, intraoperative and postoperative complications. Results: The overall stone free rate (SFRs) was 49/72 (68%) in group 1 and 57/63 (91%) patients in group 2, (P=0.005). The operative time was shorter in group 1 in comparison to group 2 with statistically significant difference (P=0.005). There was not any statistically significant difference between 2 groups in complication rate (P=0.2). Conclusıon: Both R-URS and F-URS could be a feasible option for treatment of PUS. R-URS is less successful for treatment of PUS and should be used cautiously and with availability of F-URS.

Retrospective comparative study of rigid and flexible ureteroscopy for treatment of proximal ureteral stones.

BACKGROUND: We analyzed the outcome and complications of rigid (R-URS) and flexible (F-URS) ureteroscopic lithotripsy for treatment of proximal ureteric stone (PUS). SUBJECTS AND METHODS: Retrospective data of 135 patients (93 males and 42 females) submitted to R-URS and F-URS for treatment of PUS in the period between July 2013 and January 2015 were investigated. (R-URS, group 1) was performed in 72 patients while 63 patients underwent (F-URS, group 2).We compared the 2 groups for success, stone characteristics, operative time, intraoperative and postoperative complications. RESULTS: The overall stone free rate (SFRs) was 49/72 (68%) in group 1 and 57/63 (91%) patients in group 2, (P=0.005). The operative time was shorter in group 1 in comparison to group 2 with statistically significant difference (P=0.005). There was not any statistically significant difference between 2 groups in complication rate (P=0.2). Conclusion: Both R-URS and F-URS could be a feasible option for treatment of PUS. R-URS is less successful for treatment of PUS and should be used cautiously and with availability of F-URS.

Transurethral Pneumatic Cystolithotripsy: A Novel Approach.

OBJECTIVE: Various endoscopic instruments used in treating renal stones have been used in managing bladder calculi. Our aim is to evaluate the use of transurethral ureteroscopic pneumatic cystolithotripsy for the management of large bladder calculi. PATIENTS AND METHODS: In a retrospective study conducted between May 2005 and July 2011, 53 patients with solitary bladder stones were subjected to our technique, transurethral ureteroscopic pneumatic cystolithotripsy. The mean patient age was 54.3 years. The mean stone size was 4.8 cm. Diagnostic cystoscopy was performed first. A semirigid ureteroscope with a pneumatic probe was introduced through the cystoscope sheath, and pneumatic lithotripsy was performed. The cystoscope sheath works as a draining channel, allowing bladder evacuation. The bladder collapses over the stone and, subsequently, prevents stone migration, which shortens the lithotripsy's duration. Stone immobilization allows the transmission of full pneumatic power to the stone. The stone fragments were removed through periodic bladder irrigation using an Ellick evacuation-irrigation system, and a 16F Foley catheter was placed at the end of the procedure. RESULTS: Our technique was effective in all cases, including stone-free bladders. No surgical complications were detected. The mean operative time was 83 ± 21.0 minutes, which is comparable to that of standard management. The mean duration of lithotripsy and evacuation was 29.7 ± 18.4 minutes. In the postoperative period, patients were followed up for 18 months, with no urethral stricture being reported in any case. CONCLUSION: The transurethral ureteroscopic pneumatic cystolithotripsy procedure is a safe technique for the management of large bladder calculi. It allows the bladder to collapse over the stone, leading to stone immobilization and, subsequently, decreasing lithotripsy duration. Our procedure is associated with a minimal chance of postoperative urethral injury because all stone fragments are evacuated through the cystoscope sheath, without contact with the urethral urothelium.

Golgi Phosphoprotein-3 and Y-Box-Binding Protein-1 Are Novel Markers Correlating With Poor Prognosis in Prostate Cancer.

BACKGROUND: Prostate cancer is a common and aggressive cancer among men. Despite advances in treatment, the mechanisms involved in progression are still unclear. New prognostic markers are needed to better design patient-specific therapeutic regimens. MATERIALS AND METHODS: The present study included 120 patients: 76 with prostate carcinoma, 12 with low-grade prostate intraepithelial lesions, 12 with high-grade prostate intraepithelial lesions, and 20 with benign prostatic hyperplasia. Immunohistochemical study was performed for Golgi phosphoprotein-3 (GOLPH3) and Y-box-binding protein-1 (YB-1) analysis. The correlation with clinicopathologic data and overall survival was analyzed. RESULTS: Both GOLPH3 and YB-1 showed increased expression from benign to malignant tumors. In prostate carcinoma, cytoplasmic GOLPH3 was associated with Gleason score, tumor stage, and androgen receptor status (P = .034, P < .001, and P = .008, respectively). Nuclear YB-1 expression was associated with Gleason score and androgen receptor status (P = .018 and P = .024, respectively). Cytoplasmic YB-1 expression was associated with Gleason score, tumor stage, and androgen receptor status (P = .008, P = .027, and P < .001, respectively). A high Gleason score (P = .004), high tumor stage (P < .001), and androgen receptor-independent cancer (P = .006) were the only detected adverse prognostic clinicopathologic factors. Moderate to intense GOLPH3 and high nuclear and cytoplasmic YB-1 expression correlated with shorter overall survival (P < .001, P = .020, and P < .001, respectively). On multivariate analysis, moderate to intense GOLPH3 expression was the only predictor of overall survival (P = .025). CONCLUSION: High GOLPH3 and nuclear/cytoplasmic YB-1 expression correlated with a poor prognosis in patients with prostate cancer. Both markers could be promising targets for new treatment strategies.

Management of intravesical self-inflicted sharp objects in children: 10-year single-center experience.

INTRODUCTION: Intravesical foreign bodies (FBs) are rare and have interesting pathology for urologists. There has been an increase in reports of intravesical FBs in the last few decades, but they are still considered to be rare in children, especially young girls. Here we present our experience in the assessment and management of intravesical self-inserted sharp objects in children. PATIENTS AND METHODS: We reviewed the records of children with self-introduced intravesical FBs admitted to our hospital during the last 10 years. Twenty-four cases were included in this study (20 girls and 4 boys). The presenting symptoms and methods of diagnosis and treatment were reviewed. RESULTS: The ages of the patients ranged from 4 to 12 years. In all cases, foreign bodies were self-inserted. All patients were subjected to KUB (kidney, ureter, bladder radiograph) and abdominal ultrasonography. Based on the KUB findings, the FBs in girls were found to be metal pins in 12, a hair clip in four, and a wooden pencil in three (Figure). In boys, a coiled electric wire was found in three, with a urinary calculus formed over one of them. There were small metallic objects in two cases (1 boy and 1 girl). Endoscopic removal of FBs was done successfully in 19 cases (18 girls and 1 boy), and open cystostomy was performed in four cases (3 boys and 1 girl). DISCUSSION: Intravesical FBs are important considerations in the differential diagnosis of pathological lower urinary tract symptoms. They represent significant challenges to urologists. Among children, the reasons for self-insertion of FBs might reflect psychiatric disorders. Routine psychiatric evaluations should be offered to all patients with intentional FB insertion to avoid missing any underlying psychiatric disorders. In our study, psychiatric evaluations have been advised for all the affected children and their parents. Self-inserted FBs are commonly seen in adults and are rarely encountered in children. To our knowledge, this is the largest reported series of children with self-inflicted intravesical FBs. In addition, all of the FBs in this study had one or more sharp edges that made their endoscopic extraction more difficult without causing bladder or urethral damage. In children, removal of intravesical FBs represents a great challenge, as the size of the pediatric urethra may hinder safe transurethral removal. Endoscopic handling of intravesical FBs is mostly unsuccessful in boys because of the long and narrow urethra, and open cystostomy might be the treatment of choice to save the urethra. In contrast, the short female urethra renders the endoscopic removal of intravesical FBs more successful. In this study, endoscopic removal of FBs was done successfully in 19 cases (18 girls and 1 boy), and open cystostomy was performed in four cases (3 boys and 1 girl). CONCLUSIONS: Although FBs in the urinary tract of children are very rare, they need to be considered during any evaluation of pathological lower urinary tract symptoms. Endoscopic management is feasible for most of these patients. The size, number, nature of foreign bodies, and any associated urinary calculi determine the treatment modality.

GOLPH3 and YB-1 Are Novel Markers Correlating With Poor Prognosis in Prostate Cancer.

BACKGROUND: Prostate cancer is a common and aggressive cancer among men. Despite advances in the treatment, the mechanisms involved in progression are still unclear. New prognostic markers should be explored for better design of patient-specific therapeutic regimens. METHODS: This study was performed on 120 patients stratified as 76 with prostatic carcinoma, 12 with low-grade prostate intraepithelial lesion, 12 with high-grade prostate intraepithelial lesion and 20 with benign prostate hyperplasia. Immunohistochemical study was done for Golgi phosphoprotein 3 (GOLPH3) and Y-box binding protein-1 (YB-1) analysis. Correlation with clinicopathological data and overall survival was analyzed. RESULTS: Both GOLPH3 and YB-1 showed increased expression from benign to malignant tumors. In prostatic carcinoma, cytoplasmic GOLPH3 was associated with Gleason score, stage and androgen receptor (P = 0.034, P < 0.001, and P = 0.008 respectively). Nuclear YB-1 expression was associated with Gleason score and androgen receptor (P = 0.018 and P = 0.024 respectively). Cytoplasmic YB-1 expression was associated with Gleason score, stage and androgen receptor (P = 0.008, P = 0.027, and P < 0.001 respectively). High Gleason score (P = 0.004), high stage (P < 0.001) and androgen receptor (P = 0.006) were the only detected adverse prognostic clinicopathological factors. Moderate/intense GOLPH3 and high nuclear and cytoplasmic YB-1 expression were correlated with shorter overall survival (P < 0.001, P = 0.020, and P < 0.001 respectively). In the multivariate analysis, moderate/intense GOLPH3 expression was the only predictor of overall survival (P = 0.025). CONCLUSIONS: High GOLPH3 and nuclear/cytoplasmic YB-1 expression correlated with poor prognosis in prostate cancer. Both markers can be promising targets for new treatment strategies.

Outcome of ureteroscopy for treatment of pediatric ureteral stones.

PURPOSE: We assess the efficacy and safety of semirigid ureteroscopy for treatment of ureteral stones in children. MATERIALS AND METHODS: The records of 18 non-consecutive children with symptomatic ureteral stones treated with ureteroscopy in 2008-2010 were reviewed. Mean age was 7.6 years (range 15 months-14 years). A semirigid (8F) ureteroscope was used in all cases. A 0.038-inch floppy-tipped guidewire was passed through the selected ureteric orifice, advanced under direct vision, and monitored fluoroscopically. Dilatation of the ureteral orifice was necessary in 7 cases. Either direct extraction or disintegration using a pneumatic lithotripter was performed. The follow-up period was 6 months. RESULTS: Ureteroscopic procedures were successfully completed in 16 children (89%). Stones were located at the middle ureter in 3 (19%) cases and various levels of the lower third ureter in 13 (81%) cases. Stone size was 4-10 mm (mean 7 mm). Stones were fragmented with pneumatic lithotripsy in 9 (56%) cases and removed by forceps without fragmentation in 7 (44%). Stent was left in place for 3 days to 3 weeks in 12 (75%) cases. Early postoperative complications were insignificant hematuria in 2 patients and renal colic and fever in 3 patients. No complications were observed during the period of follow up. CONCLUSION: Ureteroscopy is a feasible treatment option for ureteral stones in children, when in skilled hands and with the aid of experience gained in the adult population.

Expression of extracellular matrix metalloproteinase inducer and fascin in urinary bladder cancer: Correlation with clinicopathological characteristics.

Expression of extracellular matrix metalloproteinase inducer (EMMPRIN) and fascin have recently received considerable attention as emerging key markers of cell invasion and metastasis in various types of cancers. The present study aimed to characterize the expression of EMMPRIN and fascin in a cohort of bladder cancer patients and to verify the association with clinicopathological characteristics. Immunohistochemical analysis of EMMPRIN and fascin was performed in 125 bladder cancer specimens, including 86 transitional cell carcinoma (TCC) and 39 squamous cell carcinoma (SCC) cases. Overexpression of EMMPRIN and fascin was detected in 71.2 and 83.2% of bladder carcinomas, respectively, while neither was detectable in the normal adjacent epithelium. In SCC, EMMPRIN and fascin expression scores were found to be higher compared to TCC cases (P=0.031 and 0.053, respectively). Higher EMMPRIN and fascin immunoscores markedly correlated with tumor pathological (pT) stage in TCC (P<0.001) and SCC (P=0.004 and 0.001, respectively). High EMMPRIN expression was strongly associated with advanced grades in TCC and SCC (P=0.003 and 0.002, respectively). Cases were then stratified, according to the joint expression status of EMMPRIN and fascin, into four immunoprofiles. A highly significant association was found between various tumor immunoprofiles and pathological stage. Of those, the EMMPRIN-/fascin-positive immunophenotype was closely associated with pT3 and pT4 tumors. The findings suggested an association between increased EMMPRIN and fascin expression and increased progression of bladder cancer. Additionally, these two markers may act in concert to mediate a more aggressive behavior through enhanced tumor cell invasion.