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Background Ureteral stones pose a high economic and medical burden among Emergency Department (ED) admissions. Management strategies vary from expectant therapy to surgical interventions. Since predictors of ureteral spontaneous stone passage (SSP) are still not well understood, we sought to create a novel nomogram to guide management decisions. Methods Charts were retrospectively reviewed for patients who presented to our institution's ED with non-febrile renal colic and received a radiological diagnosis of ureteral stone ≤10 mm. Demographic, clinical, laboratory, and non-contrast CT data were collected. This novel nomogram incorporates the serum neutrophil-to-lymphocyte ratio (NLR) as a potential predictor of SSP. The model was derived from a multivariate logistic regression and was validated on a different cohort. A receiver operator characteristic (ROC) curve was constructed and the area under the curve (AUC) was computed. Results A total of 1186 patients presented to our ED between January 2010 and October 2018. We randomly divided our population into a derivation and validation cohort in one to five ratio. A stone size ≥ 7 mm was the strongest predictor of SSP failure; OR=9.47; 95%CI (6.03-14.88). Similarly, a NLR ≥ 3.14 had 2.17; (1.58-2.98) the odds of retained stone. SSP failure was also correlated with proximal position, severe hydronephrosis, and leukocyte esterase ≥ 75, p=0.02, p=0.05, and p=0.006, respectively. The model had an AUC of 0.804 (0.776-0.832). The nomogram was also used to compute the risk of SSP failure (AUC 0.769 (0.709 - 0.829). Conclusions Our novel nomogram can be used as a predictor for SSP and can be used clinically in decision making.

INTRODUCTION AND OBJECTIVE:Partial Nephrectomy (PN) is a procedure which aims to preserve renal functionality and minimize morbidity in patients with localized kidney tumors. However, it is associa...

Background Bladder cancer is the ninth most common cancer worldwide, and the third most common cancer in Lebanon. Immunohistochemistry (IHC) has been used to stratify muscle‐invasive bladder cancer (MIBC) into different subtypes. However, to our knowledge, there exists no study that investigates the use of this low‐cost technique to predict prognosis in bladder cancer patients in our region. Aim To examine the feasibility of low‐cost triple‐marker IHC assessment for MIBC subtyping in order to predict patients' survival and cisplatin sensitivity. Methods and results We collected the specimens of deceased patients diagnosed with MIBC on pathology at our institution. For each case, tumor tissue blocks were retrieved and stained for hematoxylin and eosin in addition to three molecular markers by IHC: cytokeratin 5/6, cytokeratin 14 staining basal BC, and GATA3 staining luminal BC. A cut‐off of ≥20% was set as positive. Kaplan‐Meier curves were built, factored by BC subtype, to predict overall survival (OS), disease‐specific survival (DSS), and progression‐free survival (PFS). Hazard ratios in Cox regression were also created accounting for oncological factors and BC subtype. We categorized specimens as either luminal (GATA3 positive only) (n = 21; 56.7%) or as double‐positive (GATA3 and basal cytokeratin 5/6 or cytokeratin 14 positive) (n = 16; 43.3%). The overall median survival was similar between the two categories (27.0 ± 4.82 months). Numbers favored luminal disease for PFS (Breslow P = .032). After adjusting for covariates, luminal molecular expression predicted PFS (0.28; [0.09‐0.94]). Yet, the Cox model was not able to identify any predictors of OS or DSS. Conclusion Specimens enriched with only a luminal molecular profile were more likely to exhibit cisplatin sensitivity. Despite the absence of guidelines recommending the utilization of molecular profiling in clinic practice, triple‐marker IHC could serve as a potential low‐cost prognostic indicator to identify patients at high risk of progression.

Objectifs L’enucleation endoscopique de la prostate (EEP) et l’adenomectomie prostatique robot-assistee (APR) sont deux traitements reserves aux adenomes prostatiques obstructifs de gros volumes. Peu de donnees sont disponibles comparant les deux procedures. Dans cette etude, nous comparons les resultats perioperatoire de l’EEP et l’APR utilisant une grande base de donnees nationale americaine. Methodes Nous avons utilise la base de donnees du programme national d’amelioration de la qualite chirurgicale du College americain des chirurgiens (ACS-NSQIP) pour selectionner les deux procedures (EEP ou APR) entre 2008 et 2017. Nous avons compare les complications chirurgicales classees par systeme d’organes, la duree d’hospitalisation, le temps operatoire, le taux de reintervention, et le taux de mortalite entre les deux procedures. Pour evaluer l’effet du choix de la procedure sur les resultats operatoires, nous avons effectue une regression logistique multiple et une analyse utilisant le score de propension pour mieux evaluer l’effet individuel du traitement. Resultats L’analyse a ete conduite sur 2867 patients qui ont subi une EEP et 234 patients qui ont recu une APR. Les caracteristiques demographiques et les comorbidites etaient identiques entre les deux groupes. D’apres l’analyse de regression multiple, l’APR etait associee a un temps operatoire > 90 minutes et une duree d’hospitalisation > 1 jour avec des coefficients de probabilites de [12,78 ; (7,37–22,17)] et [11,46 (8,37–15,70)], respectivement. En comparaison a l’EEP, l’APR etait liee a plus de thrombose veineuse profonde [4,48 ; (1,13–17,74)] et de transfusion sanguine en perioperatoire [5,94 (3,01–11,76)]. En outre, le score de propension a revele plus de complications cardiovasculaires et de mortalite parmi ceux qui ont subi une APR (p = 0,009 et p = 0,036, respectivement) ( Tableau 1 , Tableau 2 ). Conclusion L’EEP et l’APR sont deux techniques dediees au traitement de larges adenomes prostatiques. Notre etude est la plus grande comparant ces deux procedures. Les resultats indiquent que l’EEP possede un profil plus sur pour le traitement de l’obstruction urinaire.