[Clinical study of influential factors on renal scarring after ESWL monotherapy for renal stone disease].

OBJECTIVE: ESWL is now widely used for the treatment of renal stone disease. Although ESWL has many advantages for patients' quality of life, few reports have demonstrated the long-term outcomes of the alterations of renal morphology after ESWL. We reported renal scarring after ESWL monotherapy in patients with renal calyceal stones. In this study, we evaluated a large series of patients' cohort treated at our institution, and assessed the causal effect of ESWL on the late occurrence of renal scar formation. PATIENTS AND METHODS: ESWL was performed with EDAP (LT-01,02) that generates shock wave energy by piezoelectric discharge. We analyzed the records of 285 kidneys treated between Dec. 1986 and Nov. 1998. Renal scarring was noted in 44 kidneys and not in 241 kidneys with periodical ultrasonography. We compared the backgrounds of the two groups using chi-square or non-parametric analysis. The Kaplan-Meier method and Cox regression model determined the analysis of renal scar formation. RESULTS: Univariate and multiple regression analysis revealed that the total amount of ESWL emission and hyperuricemia independently affected the probability of renal scar formation. CONCLUSIONS: Over-emission of ESWL (over 10,000 shots) must be care for the prevention of renal scarring in patients with renal calyceal calculi, especially when associated with hyperuricemia. After ESWL, periodical checkups with ultrasonography will provide useful information for the clinical diagnosis of renal scarring.

[A clinical study on renal pelvic and ureteral cancer].

We investigated the clinicopathological features of 62 patients with transitional cell carcinoma of the renal pelvis and/or ureter who underwent total nephroureterectomy at our department from April, 1987 to October, 2000. The patients consisted of 48 males and 14 females, with a mean age of 67 years, ranging from 46 to 86 years. The mean follow-up period was 40 months. The 1-, 3- and 5-year cause-specific survival rates (Kaplan-Meier's method) for all of the patients were 90.8, 82.9%, and 68.6%, respectively. The prognostic significance of the 5 pathological factors (grade, pT, pV, pL and pN) were evaluated. All these factors affected the survival rates significantly in univariate analysis using the generalized Wilcoxon test. According to multivariate analysis by the Cox proportional hazard model, the most influential prognostic factor was grade.