Usefulness of urinalysis in following patients with distal ureterolithiasis.

PURPOSE: The determine the usefulness of urinalysis in monitoring patients with distal ureterolithiasis. MATERIALS AND METHODS: Patients with microhematuria who were found to have a distal ureteral stone and who were candidates for conservative management were enrolled in the study. Patients were typically seen in clinic at 1 to 2 weeks after initial diagnosis and reassessed. A urinalysis, including office dipstick and automated laboratory analysis using the IQ 200 IRIS analyzer, were performed. The absence or presence of microhematuria was determined and compared with results of repeated unenhanced helical CT of the abdomen and pelvis to determine the sensitivity, specificity, and positive and negative predictive values of urinalysis. RESULTS: Twenty-nine patients were enrolled in this prospective study. The mean age of the patients was 43.5 years. The sex distribution was predominantly male, with 72% men and 28% women. Ultimately, 18 patients are included in our analysis with the remainder either lost to follow-up or excluded because of protocol violation. Average distal stone size was 4.1 mm (range 2.0-6.5 mm). Stones were evenly distributed between the right and the left ureters, with 50% on either side. Mean time to follow-up was 18 days with a range of 2 to 63 days. The sensitivity of urinalysis was determined to be 40% (8%-72%) while the specificity was 63% (28%-98%). The predictive value of a positive test was 57% (19%-95%) and the predictive value of a negative test was 55 % (25%-85%). The confidence interval for each of these parameters is inclusive of the value of 50%, indicating that urinalysis is no better than randomness in predicting presence or absence of a stone by CT. CONCLUSIONS: The absence or presence of microhematuria does not accurately predict whether a distal ureteral stone has passed or is still present. In those patients who need or want to know whether a stone is still present, unless a stone is strained, we suggest repeated CT imaging.

Case report: subcapsular hepatic hematoma: retraction injury during laparoscopic adrenalectomy.

We present a case of subcapsular hepatic hematoma resulting from retraction of the liver during laparoscopic adrenalectomy. We discuss the management and prevention of this rare and important complication.

Retroperitoneal lymph node dissection in the treatment of low-stage nonseminomatous germ cell tumors of the testicle: an update.

Nonseminomatous germ cell tumors (NSGCT) of the testicle are highly treatable and curable. The evolution of cancer control for this disease has shown an effective integration of medical and surgical approaches over the last 3 decades. Current emphasis in the therapy of NSGCT focuses on minimizing treatment-related morbidity while maintaining consistently high cure rates as previously seen. Retroperitoneal lymph node dissection (RPLND) in experienced hands is a critical component of the treatment armamentarium in this disease. RPLND is an accurate staging tool providing important information to determine the need for chemotherapy. When performed properly, RPLND eliminates the retroperitoneum as a site for relapse, which in turn provides emotional and psychological relief to the patient, and simplifies the follow-up protocol. RPLND alone can also provide high cure rates in patients with low clinical stage disease and high risk factors, such as lymphovascular invasion or predominance of embryonal histology in the primary tumor. Teratoma is chemoresistant and, when present in the primary tumor of patients with low stage, may be best treated with primary RPLND. Primary chemotherapy in the treatment of low stage NSGCT deserves continual investigation as long-term toxicities become more apparent. Observation is an option for the highly motivated patient but requires a rigorous follow-up schedule to avoid relapse. Laparoscopic RPLND is a viable staging tool; however, oncologic control of the retroperitoneum has not been reliably determined.

Retroperitoneal lymph node dissection in the treatment of low-stage nonseminomatous germ cell tumors of the testicle.

Nonseminomatous germ cell tumors of the testicle are highly treatable and curable. The evolution of cancer control for this disease has demonstrated an effective integration of medical and surgical approaches over the last 30 years. Current emphasis in the therapy of nonseminomatous germ cell tumors focuses on minimizing treatment-related morbidity while maintaining consistently high cure rates. Retroperitoneal lymph node dissection in experienced hands is a critical component of the treatment armamentarium in this disease. Retroperitoneal lymph node dissection is an accurate staging tool that provides important information in determining the need for chemotherapy. When performed properly, retroperitoneal lymph node dissection eliminates the retroperitoneum as a site for relapse, which in turn provides emotional and psychological relief to the patient and simplifies the follow-up protocol. Retroperitoneal lymph node dissection alone can also provide high cure rates in patients with clinical low-stage disease and high-risk factors such as lymphovascular invasion or predominance of embryonal histology in the primary tumor. Teratoma is known to be chemoresistant and, when present in the primary tumor of low-stage patients, may be best treated with primary retroperitoneal lymph node dissection. Primary chemotherapy in the treatment of low-stage nonseminomatous germ cell tumors deserves continual investigation as long-term toxicities become more apparent. Observation is an option for the highly motivated patient, but requires a rigorous follow-up schedule to avoid relapse. Laparoscopic retroperitoneal lymph node dissection is a viable staging tool, however, oncologic control of the retroperitoneum has not been reliably determined.