Comparison of imaging modalities for detection of residual fragments and prediction of stone related events following percutaneous nephrolitotomy

Introduction

Achieving stone free status (SFS) is the goal of stone surgery. In this study it is aimed to compare effectiveness of unenhanced helical computerized tomography (UHCT), KUB and ultrasonography (US) for detection of residual RFs and predicition of stone releated events following percutaneous nephrolitotomy (PNL).

Materials and Methods

Patients underwent PNL for radiopaque stones between November 2007 and February 2010 were followed. Patients were examined within 24-48 hours after the procedure by KUB, US and UHCT. For stone size 4 mm was accepted as cut off level of significance.Sensitivity and specificity of KUB and US for detection of RFs and value of them for prediction of stone related events were calculated.

Results

SFS was achieved in 95 patients (54.9%) and when cut off value of 4 mm for RFs was employed, SFS was achieved in 131 patients (75.7%). Sensitivity was 70.5% for KUB, and 52.5% for US. UHCT was shown to be significantly more efficient for detection of RFs compared to both KUB (p=0.01) and US (p=0.001). When cut off level of 4 mm employed, sensitivity of KUB and US increased to 85.7% and 57.1%. Statistical significant superiority of UHCT still remained (p value vs. KUB: 0.03 and p value vs. US: 0.008).

Conclusion

UHCT is the most sensitive diagnostic tool for detecting RFs after PNL. It has higher sensitivity regardless of stone size compared to KUB and US. Additionally UHCT has higher capability of predicting occurrence of stone related events.     

Tissue reactions of 5 sling materials and tissue material detachment strength of 4 synthetic mesh materials in a rabbit model

PURPOSE: We evaluated tissue reactions to 5 sling materials used in tension-free vaginal tape (TVT), intravaginal slingplasty (IVS), polypropylene mesh hernia repair, the suprapubic approach to suburethral polypropylene tape (SPARC) and cadaveric fascia lata procedures. We also compared the mesh-to-tissue attachment strength of 4 sling mesh materials (TVT, IVS, surgical polypropylene mesh and SPARC) at on days 2, 7, 15 and 30 after implantation. MATERIALS AND METHODS: A total of 20 female New Zealand White rabbits were randomized to group 1-2 days, group 2-7 days, group 3-15 days and group 4-30 days. After the rabbits were anesthetized an 8 cm midline incision was made for rectus muscle access, and 0.5 x 1 cm pieces of TVT, IVS, SPARC, surgical polypropylene mesh and cadaveric fascia lata were sewn to the rectus muscle with direct contact. At the same time 4 subfascial tunnels in the medial surface of the upper extremities were prepared, and 1.0 x 0.5 cm strips of TVT, IVS, SPARC and polypropylene mesh were implanted in each tunnel. On days 2, 7, 15 and 30 after implantation mechanical testing was performed to define tissue detachment strength. The strips of 5 sling materials were then harvested with the surrounding tissue. Specimens were studied by light microscopy. RESULTS: Mean detachment strength, that is the minimum weight needed to move the mesh, of the synthetic meshes from days 2 to 30 were 291.6 to 2,390.0 gm for TVT, 178.4 to 2,160.0 gm for SPARC, 188.4 to 1,850.0 gm for hernia mesh and 92.8 to 1,510.0 gm for IVS (at all data points TVT vs IVS p < 0.05). Light microscopy revealed a quite uniform tissue reaction with a sign of marked acute inflammation in and around the mesh fibers on days 2 and 7 after implantation. All meshes showed stable fibrosis and muscle infiltration on day 30. CONCLUSIONS: All 5 synthetic sling materials produce similar tissue reactions beginning soon after implantation. Cadaveric fascia lata persisted in tissue with remarkable perifascial fibrosis at day 30. When comparing the 4 polypropylene mesh materials; the attachment capacity of TVT was superior and that of IVS was the least of the 4. TVT was statistically better than IVS at all data points. SPARC and hernia mesh provided results similar to those of TVT.     

Snodgrass hypospadias repair with ventral based dartos flap in combination with mucosal collars

OBJECTIVE: In this study, we report our results of Snodgrass hypospadias repair in conjunction with use of ventral based vascularized dartos flaps. In all repairs, mucosal collars were created and incorporated into the repair to create a more normal appearing circumcised penis, as described by Firlit. PATIENTS AND METHODS: Records of 60 patients with distal or mid-penil hypospadias who underwent standard Snodgrass repair were evaluated. During circumscribing incision mucosal collars were preserved and used to create a normal appearing circumcision line. A ventral based vascular dartos tissue was preserved as a flap and used as a second layer to cover the entire neourethra before glans closure. RESULTS: All repairs were completed in 1 stage. Mean follow-up was 10.5 months (3-37 months). There were 5 (8.3%) cases of fistula and 6 (10%) cases of meatal stenosis. All patients with fistula formation had meatal stenosis. All patients, except for patients with fistula and/or metal stenosis, were voiding a straight stream and have a slit like meatus with cosmetically normal looking circumcised penis. CONCLUSION: Ventral based flaps are easier to harvest and transpose to cover the neourethra. Combining repairs with mucosal collars enhances the cosmetic results and makes the ventral flap harvesting process easier.     

The cutoff level of free/total prostate specific antigen (f/t PSA) ratios in the diagnosis of prostate cancer: A validation study on a Turkish patient population in different age categories

We investigated an optimal cutoff level of free/total PSA ratios (f/t PSA) in predicting prostate cancer in different age groups, focusing on the avoidance of unnecessary prostate biopsies. A total of 4955 men were enrolled into the study. Serum tPSA, fPSA, and f/t PSA ratios were determined for the study population. All males who had suspicious digital rectal examination and tPSA > 4 ng/mL underwent transrectal ultrasonography-guided prostate biopsy. Receiver operating characteristic (ROC) curves for each group were generated by plotting the sensitivity versus 1-specificity for the f/t PSA ratio. The sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR) were obtained using various f/t PSA ratio cutoffs for different age groups. There were 657 patients with a PSA level of 4–10 ng/mL. According to sensitivity and specificity f/t% PSA cutoff points were determined to be 10%, 15%, 15%, and 10% in 50–59 years, 60–69 years, >70 years, and all ages categories, respectively, in patients with initial PSA level of 4–10 ng/mL. f/t PSA ratio had an area under the curve (AUC) value of 0.81 (95% confidence level: 0.80–0.82) for all age groups in detecting prostate cancer. f/t PSA ratio has an AUC value of 0.669 (0.632–0.705) in detecting prostate cancer among patients with a PSA level of 4–10 ng/mL. Ten percent of f/t PSA ratio had the highest specificity with PLR and 30% f/t PSA ratio had the highest sensitivity with lower NLR in the all-age categories. The current study shows that the use of f/t PSA ratio in patients with PSA levels of 4–10 ng/mL should enhance the specificity of PSA screening and decrease the number of unnecessary biopsies. The age-related changes warrant further investigation in a large, multicentric, and multinational population to improve the clinical use of f/t PSA cutoffs.     

Significance of second transurethral resection on patient outcomes in muscle-invasive bladder cancer patients treated with bladder-preserving multimodal therapy

Purpose

Although the role of second transurethral resection of bladder tumor (TURB) is well established in high-risk non-muscle-invasive bladder cancer, to the best of our knowledge, there is no study regarding the role of a second transurethral resection (TUR) after a complete first TURB in multimodal therapy (MMT). The aim of this study was to evaluate the role of a second TUR on disease-specific survival (DSS) and overall survival (OS) rates in muscle-invasive bladder cancer (MIBC) patients who were treated with MMT.

Methods

We assessed the data of 90 patients (stage T2-4, N0-1, M0 urothelial cancer) who were treated with MMT at our clinic between January 2000 and June 2014. Patients with incomplete initial TURB were excluded. A total of 43 patients had a second TUR before starting radiochemotherapy of MMT (group 1), and 47 patients (group 2) were treated with MMT without having a second TUR. The impact of second TUR on DSS and OS rates was the primary outcome measure of the study.

Results

Mean (SD, range) age and mean follow-up of the patients were 65.1 (7.1, 52–81) years and 60.3 (38.3, 6–159) months, respectively. The two groups were similar with regard to sex, age, presence of hydronephrosis, lymph node involvement and stage. The 5-year DSS rate was better in group 1 compared to group 2 (68 vs. 41 %) (p = 0.046). The 5-year OS rates of the patients were 63.7 and 40.1 % in groups 1 and 2, respectively (p = 0.054). Multivariate analysis revealed that second TUR, lymph node involvement, presence of hydronephrosis and tumor stage were independent prognostic factors for DSS.

Conclusions

Second TUR should be performed in patients with MIBC who are going to be treated with bladder-preserving MMT protocols.

     

Hydrodilation of the ureteral orifice in children renders ureteroscopic access possible without any further active dilation

PURPOSE: We review our experience with hydrodilation of the ureteral orifice for ureteroscopic access in children. MATERIALS AND METHODS: We retrospectively reviewed the results of 30 ureteroscopic procedures performed in 26 children who were followed for 6 months. Ureteral access was obtained with the assistance of a hand irrigation pump without any further active dilation in all cases. RESULTS: A total of 26 patients (86.7%) were completely stone-free after 1 procedure. There was no major complication such as ureteral perforation or avulsion. Mild flank pain was observed in 8 cases (26.7%). Predominant symptoms of bladder spasm were observed in 6 cases (20%). At 6-month followup no patient had pyelonephritis or demonstrated hydronephrosis related to ureteral stricture. CONCLUSIONS: Our study shows that hydrodilation of the ureteral orifice in children renders ureteroscopic access possible with no additional active dilation and no associated complications.     

Liver metastases of neuroendocrine tumors: is it possible to diagnose different histologic subtypes depending on multiphasic CT features?

Abdominal Radiology - To assess and compare the multiphasic computed tomography (CT) features of neuroendocrine tumor (NET) liver metastases and to investigate the possibility to predict the...     

The value of perioperative mitomycin C instillation in improving subsequent bacillus calmette-guerin instillation efficacy in intermediate and high-risk patients with non-muscle invasive bladder cancer: a prospective randomized study

Purpose: We evaluated the efficacy of perioperative mitomycin C (MMC) instillation to improve subsequent bacillus Calmette-Guérin (BCG) instillation efficacy in intermediate and high risk patients with non-muscle invasive bladder cancer (NMIBC). Materials and Methods: From November 2004 to May 2006, 51 patients with intermediate or high risk NMIBC were enrolled in this prospective randomized trial. In group A, patients were treated with perioperative MMC (40 mg MMC in 40 mL saline was administered within 6 hours of surgery) followed by delayed (at least 15 days from surgery) BCG instillations (once a week for 6 weeks, 5 x 108 colony-forming units in 50 mL saline). Patients in group B were treated with delayed BCG instillations alone. The primary end points were recurrence-free interval and recurrence rate. Results: There were 25 and 26 patients in groups A and B, respectively. Median follow-up was 41.3 months (range 8 to 64) in group A and 40.9 months (range 6 to 68) in group B. Recurrence rate was 36 % (9 of 25) and 19.3 % (5 of 26) in group A and B, respectively (p = 0.052). Median time to the first recurrence was 8 months in group A and 7 months in group B (p = 0.12). Conclusions: The present study showed no statistically significant difference in terms of recurrence rate and median time to first recurrence between intermediate or high-risk patients with NMIBC who were treated with early single dose instillation of MMC plus delayed BCG and those who were treated with only BCG.     

Distribution of cervical and breast cancer risk factors in women and their screening behaviours

Breast cancer and cervical cancer are important causes of cancer‐related mortality in women all over the world. The present study was conducted in order to investigate the distribution of cervical and breast cancer risk factors in women and their knowledge and behaviours about cancer screening methods. The study is cross‐sectional in nature. It was conducted with the participation of 1,886 women in Turkey. Data were collected through a questionnaire. The knowledge and behaviours of women aged 40 and over about breast cancer or cervical cancer screening methods were investigated according to the education level; results showed that the rates of those who knew and did breast self‐examination were significantly lower in illiterate women. Besides, the rates of women who did breast self‐examination were significantly lower in those who were aged 40 and over, and the rates of those who had clinical breast examination and Pap smear test were significantly lower in women aged 39 and below (p < 0.01). This study identified the most notable breast and cervical cancer risk factors as low education levels, high number of deliveries, short breastfeeding period, obesity and low socio‐economic level. For this reason, public health policies should be developed to minimise these risk factors.     

Urinary ultrasonography in screening incidental renal cell carcinoma: is it obligatory?

Purpose  

To analyze the rate of incidental renal carcinoma in patients with no upper urinary tract symptoms (UUTS) or hematuria depending on the sonography reports and medical records of the patients and to determine whether there is a need for routine US screening for RCC.