Two Cases of Strictures after Percutaneous CT-Guided Radiofrequency Ablation for Renal Cell Carcinoma.

Percutaneous radiofrequency ablation is a safe and effective minimally invasive treatment option in selected patients with T1a tumors of the kidney with a low complication rate. We describe two cases that developed the rare but severe complication of thermal injury-induced strictures of the upper urinary tract and its consecutive management.

Can a Simple Geriatric Assessment Predict the Outcome of TURP?

PURPOSE: To determine the impact of a simple preoperative geriatric assessment on the outcome in older patients with recurrent urinary retention who underwent desobstructive surgery. PATIENTS AND METHODS: Patients aged 75 years or older with recurrent urinary retention referred for TURP entered this prospective, multicentre study. Several demographic, intra- and postoperative parameters were assessed. Preoperative geriatric assessment was performed by the 7-item Canadian Study of Health and Ageing (CSHA) frailty scale (1: very fit, 7: severely frail; completion takes less than a minute). The main outcome parameters were successful voiding rates at discharge and 3 months postoperatively. RESULTS: A total of 54 patients were recruited; 42 (77.8%) patients had a CSHA index of 1-3 and were considered as "fit", the remaining 12 (22.2%) formed the "frail" group (CSHA index 4-7). Age was identical in both cohorts (79.5 ± 3.7 vs. 79.7 ± 3.3 years); differences were demonstrable for the American Society of Anesthesiologists (ASA) score (p = 0.001), the number of daily medications (>4: 32 vs. 75%, p = 0.02), falls within the past 6 months (12 vs. 33%), and the necessity of home/nursing care (5 vs. 42%, p = 0.004). Intra- and perioperative complications, duration of postoperative catheterization, and length of hospitalization were identical in both cohorts. The success rate at discharge was 80.6% in fit and 75.0% in frail patients; the respective values at 3 months were 95.2 and 83.3%. CONCLUSIONS: A simple 1-min geriatric assessment tool can predict - to a certain extent - the outcome of desobstructive surgery in older patients with recurrent urinary retention. Fit patients achieve an excellent outcome while frail patients might benefit from a more in-depth urodynamic/geriatric evaluation.

Renal Papillary Hyperplasia as a Cause of Persistent Asymptomatic Microhematuria.

Asymptomatic microscopic hematuria (AMH) is incidentally found during routine health screenings. In the clinical evaluation of persistent AMH imaging modalities, CT urography, MR urography, and retrograde pyelography are of diagnostic importance. In case of pathologic findings (e.g., contrast-filling defects), endoscopic evaluation is mostly performed. To our knowledge, we report the first case of a patient with persistent AMH caused by biopsy-proven renal papillary hyperplasia.

Impact of hours worked by a urologist prior to performing ureteroscopy on its safety and efficacy.

OBJECTIVE: The aim of this study was to evaluate the impact of hours worked by a urologist before performing ureteroscopy on its safety and efficacy. MATERIALS AND METHODS: Patients treated at a single institution from January 2010 to December 2013 were analyzed. The study assessed patient, stone and surgical parameters, stone-free rates and intraoperative complications performed in three work duration categories: less than 6 h, 6-12 h and more than 12 h of urologist's work. Statistical analyses included the chi-squared test, Kruskal-Wallis test, and univariate and multivariate logistic regression analyses. RESULTS: In total, 469 ureteroscopies were analyzed. Intraoperative complications differed non-significantly in the corresponding time categories: ureteral perforations (< 6 h 4.4%, 6-12 h 3.2%, > 12 h 7%, p = 0.46) and avulsions (all 0%). Rates for complete stone removal were 82% within the first 12 h vs 70.2% after 12 h (p = 0.03). Corresponding partial stone-free rates were 4.1% vs 3.5% (p = 0.83) and rates of unsuccessful ureteroscopy were 13.8% vs 26.3% (p = 0.01). In multivariate regression analysis, patients treated after 12 h of urologist's work had a 2.4 times higher risk of an unsuccessful ureteroscopy [odds ratio (OR) = 2.4, 95% confidence interval (CI) 1.2-4.7, p = 0.001] and lower chances of complete stone removal (OR = 0.46, 95% CI 0.24-0.89, p = 0.02). The odds of ureteral perforations were similar (p = 0.28). CONCLUSION: Work duration before ureteroscopy did not affect its safety. Stone-free rates decreased with increasing working time. Working time exceeding 12 h was identified as an independent risk factor for impaired stone-free rates.

Does a retrograde pyelography prior to ureteroscopy influence stone-free rates and complication rates in ureteral calculi?

OBJECTIVES: To evaluate the impact of retrograde pyelography (RPG) in patients treated with ureteroscopy (URS) for ureteral calculi. METHODS: Retrospective analysis of patients treated with and without RPG prior to URS at a single institution from 2010 to 2013. Assessment of stone-free rates and intraoperative complications. RESULTS: Out of 469 URS, 211 (45%) were done with and 258 (55%) without RPG. Complete stone removal was achieved in 86.8% without RPG compared to 73% with RPG (p=0.0001). Partial stone removal rates were similar in both groups (p=0.77). Stone removal was not achieved in 9.3 vs. 22.7% (p=0.0001), with concordant findings in the distal (7.4 vs. 16.9%, p=0.007) and the proximal ureter (14.5 vs. 38.6%, p=0.002). Patients with RPG had a threefold higher chance of an unsuccessful URS (OR 3.05, 1.71-5.43, p<0.0001) and were less likely of having a complete stone removal (OR 0.37, 0.22-0.61, p<0.0001). Ureteral avulsions (0%) and ureteral perforation rates were similar (4.7 vs. 3.8%, p=0.65). CONCLUSIONS: Patients treated with an RPG prior to URS had significantly inferior stone-free rates. RPG was identified as an independent risk factor for inferior results. RPG neither facilitates nor diminishes complication rates during URS.