Endoscopic stented ureterocystostomy.

BACKGROUND AND PURPOSE: Fibrotic or neoplastic obstruction of the terminal ureter and ureterovesical junction can preclude internal drainage with a Double-J catheter. Some minimally invasive alternatives are described in the literature to avoid a percutaneous nephrostomy. We present a pure endourologic technique. PATIENTS AND METHODS: In six patients with an obstructed upper urinary tract, after the introduction of iodine contrast, the ureter was punctured with a needle to introduce a guidewire in the urinary tract under cystoscopic and fluoroscopic control. The alternative path between the bladder and ureter was then dilated up 10F to facilitate the Double-J catheter introduction. RESULTS: All six patients had their obstructed urinary tract drained with a Double-J catheter inserted above the level of obstruction. No complication was verified. CONCLUSION: Internal urinary tract drainage with a Double-J catheter was accomplished using endourologic principles in six patients, avoiding a percutaneous nephrostomy or other more invasive procedures.

Efficiency of 6- and 12-punctures biopsies to detect prostate cancer in patients with PSA< 10 ng/mL and normal digital rectal examination

OBJECTIVE: Establish the efficiency of 6- and 12-punctures transrectal ultrasound-guided needle biopsies in low risk patients for prostate cancer. Six-punctures (sextant) biopsies were compared to 12-punctures biopsies, assessing which is the best strategy to detect this neoplasm. MATERIALS AND METHODS: Among 240 patients submitted to prostate biopsy, 54 with suspected small and organ-localized tumors (prostatic specific antigen < 10 ng/mL and digital exam of the prostate not suggesting cancer) in glands < 50 cm³ were selected, constituting a homogenous sample. These patients were submitted to standard 3-punctures (basal, mid, and apical) sextant biopsy in parasagittal midline of each prostatic lobe, with 3 additional lateral punctures, bilaterally. Each specimen was separately submitted to histological study. RESULTS: Twenty-two (40.7 percent) patients had prostatic cancer, and 28 presented prostatic hyperplasia, associated or not to inflammatory conditions. High-grade prostatic intraepithelial neoplasia (PIN) was detected in 4 patients. From 22 tumors detected by 12-punctures biopsies, 6-punctures biopsies in the parasagittal midline (sextant) diagnosed 50 percent of the cases, while isolated lateral punctures diagnosed 90.9 percent of the malignant neoplasms. Basal lateral punctures responded for 72.7 percent of the cancer diagnosis, while basal sextant punctures responded only for 9.1 percent of the cases. CONCLUSION: For low risk prostate cancer, patientsÆ 12-punctures biopsy was more effective, for sextant biopsy failed to diagnose half of the cases of neoplasm. Three lateral punctures (basal, mid, and apical), with 2 additional punctures in the parasagittal midline (mid and apical) bilaterally are suggested as the best biopsy strategy

Efficiency of 6- and 12-punctures biopsies to detect prostate cancer in patients with PSA

OBJECTIVE: Establish the efficiency of 6- and 12-punctures transrectal ultrasound-guided needle biopsies in low risk patients for prostate cancer. Six-punctures (sextant) biopsies were compared to 12-punctures biopsies, assessing which is the best strategy to detect this neoplasm. MATERIALS AND METHODS: Among 240 patients submitted to prostate biopsy, 54 with suspected small and organ-localized tumors (prostatic specific antigen