Repositioning and removal of an intra-renal migrated ureteric Memokath stent.

The increasing use of ureteric stents including permanent ones is not without their own set of problems. The authors describe the difficulties encountered and a novel technique to reposition a permanent ureteric stent migrated into the kidney with an illustrated case. The same technique can also be applied to a-traumatically remove the stent if required.

DNA ploidy as a prognostic factor in muscle invasive transitional cell carcinoma of the bladder.

Radical cystectomy represents the treatment of choice for muscle-infiltrative bladder carcinoma; however, about 50% of patients relapse and die from the disease. In the present study, the prognostic significance of the DNA ploidy in transitional cell carcinoma of the urinary bladder (TCCB) is analyzed. The study was carried out on 66 patients with TCCB who underwent radical cystectomy. DNA ploidy was determined by flow cytometry (FCM) on paraffin-embedded specimens, and the results were analyzed and correlated with the tumor malignancy grade and stage and the clinical course. Forty of the 66 tumors studied (63%) were aneuploid. Aneuploid status was correlated with higher tumor T stage (P < 0.001) and grade (P < 0.001). Median follow up was 68 months (range: 12-105). Median survival was significantly longer in patients with diploid tumors (> 60 vs 45 months, P < 0.001). All patients with diploid tumors were alive and free of bladder cancer during follow-up, in contrast to only 30% of patients with aneuploid tumors. DNA ploidy was an independent prognostic factor, as shown by multivariate analysis (P = 0.006). All patients with pT > or = 3b and diploid tumors were alive at the time of analysis as opposed to none with aneuploid tumors. The results of this study suggest that DNA ploidy can provide prognostic information on patients with muscle invasive carcinoma of the bladder and might represent a means of selection for postoperative management.

Retrograde acucise endopyelotomy: is it worth its cost?

PURPOSE: To identify patients with ureteropelvic junction (UPJ) obstruction who will benefit from endoscopic Acucise incision of the stenosis and to compare the open Hynes-Anderson pyeloplasty with this minimally invasive technique. PATIENTS AND METHODS: In a prospective trial, 22 patients with primary and secondary UPJ obstruction were treated by Acucise endopyelotomy, and 18 patients were treated by Hynes-Anderson pyeloplasty. Preoperative and postoperative renal scans were used to determine the degree of obstruction and intravenous urography, ultrasound scanning, or both to assess the degree of dilation. RESULTS: There was a vast difference in the cure rate of the two groups: Hynes-Anderson pyeloplasty cured 94.5% of the patients, while in the Acucise group, the cure rate was only 32%. There was some improvement in another 22% of the patients, but the renal scan curve remained obstructed. The remaining 45% of patients failed to show any improvement. CONCLUSION: Acucise endopyelotomy will improve or cure only patients with good renal function and mild dilation of the pelvicaliceal system. Patients with severe dilation should be treated by Hynes-Anderson pyeloplasty.

Comparison of success rates and financial cost of extracorporeal shock-wave lithotripsy in situ and after manipulation for proximal ureteral stones.

Our aim was to compare the stone free rate and the financial cost between in situ and after manipulation shock wave lithotripsy (SWL) for proximal ureteral stones. A total of 130 patients with proximal ureteral stones were prospectively randomized into two groups. Sixty-five patients (group 1) underwent SWL in situ and 65 patients (group 2) underwent SWL after an attempt was made to push back the stone into the kidney with the help of a ureteral catheter. The mean per person financial cost of both techniques was estimated after a follow up period of 3 months. The stone free rate 1 month post treatment was 83% (54/65 patients) for group 1 and 95% (62/65) for group 2. The higher success rate at 1 month for the pushback group was statistically significant ( P=0.04) but was correlated with a higher cost (euro 852 vs euro 1008.5). Fifteen additional sessions of SWL and follow up visits were needed in group 1, therefore making the final costs of the two therapeutic pathways almost equal (euro 1050.9 vs euro 1088.9), with no great difference in the overall fragmentation rates at 3 months between groups (94% and 97%, respectively). Stone manipulation offers higher stone free rates faster than in situ extracorporeal SWL, but is more expensive. This disparity in cost is diminished when costs are corrected for follow-ups and treatment of complications.

Management and follow-up of impacted ureteral stones.

INTRODUCTION: Impacted stones are those that remain unchanged in the same location for at least 2 months. MATERIALS AND METHODS: We evaluated 42 patients with impacted ureteral stones, and followed them for two and a half years to check for long-term results. The calculi location included all three segments of the ureter (proximal, mid and distal). Patients' age ranged from 22 to 83 years (mean 52.5 years). Primarily, patients were manipulated with extracorporeal shock wave lithotripsy (ESWL) in situ, or following stenting. If the result was not satisfactory, then we proceeded to retrograde ureteroscopy and ureterolithotripsy. Open ureterolithotomy was our final choice. RESULTS: Thirty-six of the 42 patients (85.7%) were stone-free without the need of an open procedure. Follow-up period ranged from 10 up to 40 months, with a median period of 30 months and was achieved in 30 patients (71.4%). Stone recurrence was noted in 4 cases, while hydronephrosis without evidence of stone presence in 2. CONCLUSIONS: The initial approach for the treatment of impacted lithiasis should be attempted by ESWL. If this fails, alternative therapeutic solutions such as endoscopy can result in removal of the stone.

Biopsies of the transitional zone of the prostate. Should it be done on a routine basis, when and why?

PURPOSE: In this prospective study we try to evaluate the necessity of performing additional transitional zone biopsies as part of the standard sextant biopsies procedure in order to detect prostate cancer. MATERIALS AND METHODS: During a 12-month period we performed biopsies in 420 patients. All patients had two additional biopsies of the transitional zone biopsies. 289 of them were biopsies for the first time because they had an elevated PSA and/or a suspicious DRE. One hundred and thirty-one had a repeat biopsy because of the remaining elevated PSA after the previous negative one. RESULTS: Of the 420 patients 143 (34%) had cancer, with 11 (7%) having cancer in the transitional zone only. Patients initially evaluated because of high PSA and or a positive DRE had only 2 (2.1%) cancers exclusively in the transitional zone. We found that this percentage rises (18.7%) when the patients had already at least one previous negative biopsy of the peripheral zone, and during the repeat biopsy the transitional zone is samples. CONCLUSIONS: The low yield of transitional zone biopsies (2.1%) during first time sampling of the prostate does not warrant their systematic use for the early detection of prostate cancer. Instead the effectiveness of biopsies in that area is higher when the biopsy is repeated after an initial previous negative biopsy of the peripheral zone.