Computerized tomography attenuation values can be used to differentiate hydronephrosis from pyonephrosis.

PURPOSE: To determine the diagnostic value of computerized tomography (CT) in differentiating pyonephrosis from hydronephrosis on the basis of attenuation values (Hounsfield unit-HU). METHODS: Data of the patients with grades 1-3 hydronephrosis on abdominopelvic CT, who underwent nephrostomy tube placement for decompression of the collecting system, were retrospectively analyzed. Patient demographics and CT findings were recorded along with the first access urine culture results. Three physicians calculated the surface areas and the attenuation values of the dilated collecting systems using the system software. Mean HU of pyonephrosis and hydronephrosis cases was compared. RESULTS: A total of 105 patients with the mean age of 47.7 ± 15.5 (range 20-80) were included. The interclass correlation coefficient of three physicians was 0.981 for HU measurement and 0.999 for calculation of collecting system surface area. Of the patients, 47 (44.8 %) had pyonephrosis. Mean surface areas of the collecting system were similar in patients with pyonephrosis and hydronephrosis (1481.13 ± 1562.94 vs. 1612.94 ± 2261.4 mm2, p = 0.735). Urine cultures were positive in all patients with pyonephrosis, whereas 12.7 % of hydronephrosis cases had bacterial in first access urine culture. The HU of the patients with pyonephrosis was significantly higher that that of patients with hydronephrosis (13.51 ± 13.29 vs. 4.67 ± 5.37, p = 0.0001). Having a HU of 9.21 or over diagnosed pyonephrosis accurately with 65.96 % sensitivity and 87.93 % specificity. CONCLUSION: Measuring attenuation values of the collecting system may be useful to differentiate pyonephrosis from hydronephrosis. Diagnosing pyonephrosis accurately may avoid septic complications.

Perioperative, pathologic, and early continence outcomes comparing three-dimensional and two-dimensional display systems for laparoscopic radical prostatectomy--a retrospective, single-surgeon study.

PURPOSE: To examine perioperative, pathologic, and early continence outcomes of laparoscopic radical prostatectomy (RP) aided by a new-generation three-dimensional (3D) display system and compare them with those from the same operation aided by a conventional, two-dimensional (2D) display system. PATIENTS AND METHODS: A total of 95 consecutive patients underwent laparoscopic RP for clinically localized prostate cancer (PC) by an experienced single surgeon from October 2009 to December 2012. Baseline characteristics, perioperative and pathologic variables, and continence data at 3 months after surgery were retrospectively reviewed from a prospectively maintained database. Categoric and continuous variables were compared using chi-square, Student t, and Wilcoxon rank-sum tests, as appropriate. RESULTS: A total of 29 patients underwent laparoscopic RP using a 3D display system and 66 patients underwent laparoscopic RP using a 2D display system. The two groups were comparable for all clinical and pathologic variables. Mean total operative time for the 3D group was 131 minutes (standard deviation [SD]±18) compared with 190 (SD±31) for the 2D group (P<0.001). Mean time to perform the urethrovesical anastomosis was 28 minutes (SD±6) for the 3D group compared with 87 minutes (SD±17) for the 2D group (P<0.001). Blood loss was lower in the 3D group, and the difference was statistically significant (P<0.001). A statistically significant higher number of patients in the 3D group had early recovery of continence compared with patients in the 2D group (14/28 (50%) patients in the 3D group vs 16/64 (25%) patients in the 2D group, P=0.02). CONCLUSIONS: Laparoscopic RP aided by a new-generation 3D display system is associated with shorter operative times, reduced blood loss, and higher early continence rates in comparison with that aided by a 2D display system. In particular when considering economic issues, 3D laparoscopic RP may represent an acceptable alternative to robot-assisted laparoscopic RP.