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Objective: To describe our en bloc technique of retroperitoneal lymph node dissection (RPLND) during retroperitoneal laparoscopic radical nephroureterectomy for upper urinary tract urothelial carcinoma and evaluate perioperative outcomes., Methods: From 2002 to 2015, 114 patients with urinary tract urothelial carcinoma located at the pelvis or upper or middle ureter underwent retroperitoneal laparoscopic radical nephroureterectomy at 2 institutions. Performance of RPLND began in February 2009. The template of RPLND included the renal hilar and para-aortic lymph nodes (left side) and the renal hilar, paracaval, retrocaval, and intra-aortocaval lymph nodes (right side). After incising Gerota fascia longitudinally, the aorta (left side) or inferior vena cava (right side) was exposed, and the lymphatic and surrounding fatty tissue in the template and kidney was dissected in a single monoblock. Preoperative data were compared between the RPLND and the no-RPLND groups using propensity score matching., Results: In total, 32 matched pairs were evaluated. RPLND was successfully accomplished without open conversion in all cases. The operative time in the RPLND group was approximately 100 minutes longer than that in the no-RPLND group, but there was no significant difference in the blood loss volume or complication rate. The pathologic stages were similar in both groups. The mean number of retrieved lymph nodes was 10.7 (range 3-27), and lymph node metastasis was detected in 5 (16%) cases., Conclusion: Retroperitoneoscopic en bloc RPLND permits complete and radical removal of the lymphatic tissue contained in the RPLND template. Our en bloc technique is a safe and feasible procedure with comparable blood loss and complication rates., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Objective: To investigate the efficacy of plain radiography and ultrasonography, each as the sole imaging tool as well as combined, for detecting renal stones using unenhanced computed tomography as a standard reference. Ultrasonography and plain radiography of the kidneys, ureters, and bladder are often used for urinary tract stone detection, but the effectiveness of each method used alone, or the 2 methods used together, remains controversial., Materials and Methods: From January 2012 to September 2014, 822 patients underwent plain radiography, ultrasonography, and unenhanced computed tomography on the same day. The sensitivity and specificity of the 2 modalities to detect stones were evaluated. We compared the sizes of stones on plain radiography and ultrasonography with their size on unenhanced computed tomography., Results: Of 1644 kidneys, unenhanced computed tomography detected at least 1 stone in 994 kidneys. Ultrasonography and plain radiography detected at least 1 stone in 882 and 488 kidneys, yielding a sensitivity of 88.7% and 49.1% and a specificity of 68.3% and 99.1%, respectively. Of 488 stones detected by plain radiography, 476 stones were also detected by ultrasound, with a sensitivity of 89.9% and specificity of 68.1% for the combination of the 2 modalities. The detection rate for plain radiography for stones <5 mm was low. Stone sizes measured by the 2 modalities positively correlated with those obtained by computed tomography, and the concordance rate based on size was similar., Conclusion: Plain radiography is of limited value for detecting small renal stones <5 mm., (Copyright © 2017 Elsevier Inc. All rights reserved.)