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OBJECTIVE To identify the effect of the presence of a ureteric stent on the outcome of extracorporeal shockwave lithotripsy (ESWL), by comparing patients with ureteric stones with matched-pair analysis. PATIENTS AND METHODS Patients undergoing ESWL with the Sonolith Vision lithotripter (Technomed Medical Systems, Vaulx-en-Velin, France) were identified from our prospectively maintained database. Only adult patients with a solitary, radio-opaque, previously untreated ureteric stone were considered for further analysis. A follow-up of ≥3 months with a plain abdominal film was used to identify residual fragments. Patients were exactly matched for gender, side, location in the ureter and size (in two dimensions, within ±2 mm). If both diameters could not be matched exactly, the size was extended to ±1 mm and then to ±2 mm of both diameters. An effort was finally made to match patients by age. The treatment outcome in terms of stone-free rates was assessed and compared using McNemar’s test. RESULTS In all, 45 patients with a ureteric stent in place during ESWL were identified. The only patient who could not be adequately matched was a 40-year-old man with an 8 × 3 mm stone in the upper ureter. The best/closest match for age was selected. Most stones were in the upper ureter (77%); the mean stone size was 8.5 and 8.6 mm, respectively, with no statistical differences between the groups for age and size of stones ( P = 0.41 and 0.86, Student’s t-test). In 12 pairs, only patients with no stent were stone-free, compared to two pairs where the patient with a stent was stone-free. Using McNemar’s test, the odds ratio was 6.0 (95% confidence interval 1.3–55.2) and the difference between the groups was statistically significant ( P = 0.016). CONCLUSION These results show that the presence of a stent is associated with a worse outcome after ESWL for ureteric stones. Ureteric stents should still be used in cases of obstruction, when there is a risk of sepsis, and in patients with intolerable pain or deteriorating renal function. However, their use in patients offered ESWL for ureteric stones should be considered with caution. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Shock wave lithotripsy (SWL) has radically changed treatment of stone disease and appears to be the first option for the majority of patients. This review of current literature focused on suggestions for optimising technique, patient selection, results, and lithotriptor comparison for SWL. Methods: Literature search for SWL was performed for recently published papers in English language. Topics of interest were treatment protocols; patient evaluation; pre-SWL prediction of outcome; lithotriptor technology; efficacy; and methods to assess the effects, decrease complications, and compare lithotriptors. Earlier classic papers on SWL and guidelines for stone disease were also reviewed. Results: Recent literature contained important recommendations about SWL concerning (1) methods to predict stone fragmentation; (2) identification of factors contributing to treatment failure for lower pole and ureteric calculi; (3) guidelines from urological associations; (4) manoeuvres and changes in SWL delivery (slower rate, twin-pulse technique) to increase efficacy and decrease complications; (5) clarification of the role of medical treatment (antibiotics, α-blockers); (6) role of SWL in calyceal stones, CIRF, and abnormal kidneys; (7) obesity and SWL; and (8) methods to evaluate and compare lithotriptors. Conclusions: SWL delivered in an outpatient setting as an anaesthesia-free treatment is still considered the first option for the majority of stones with a minimal number of complications. Better understanding of the physics of shockwave delivery is required, together with treatment optimisation by limiting renal damage and better selection of patients because this approach will offer maximum benefit to patients and physicians, as well as more cost-effective treatment. [Copyright &y& Elsevier]

The article assesses the laparoscopic nephroureterectomy (LNU) and endoscopic treatment for upper urinary tract transitional cell carcinoma (UUT-TCC). In LNU, the kidney and ureter are removed by either a retroperitoneal or a transperitoneal approach. The removal of the ureter is an important step for the whole procedure. The ureteroscopy management of UUT-TCC has resulted in a successful outcome in a significant proportion of patients.

Objective To study the characteristics of patients with incidental prostate cancer. Material and methods The proportion of incidentally diagnosed prostate cancer was investigated in patients who underwent transurethral resection of the prostate (TURP) at our clinic over a 5-year period. "True" incidental prostate cancer was defined as cases where the preoperative digital rectal examination (DRE) and the prostate-specific antigen (PSA) value were normal. Patients with known malignancy of the prostate were excluded, together with those with PSA >4 ng/ml and/or a positive DRE. The characteristics of these patients were compared to those of benign prostatic hyperplasia patients and the group as a whole. Results Of the 786 patients operated on between 1999 and 2003, 34 (4.3%) had a positive pathology report for "true" incidental prostate cancer. An increased frequency of poorly differentiated tumors (32.3%) was noted. Of the 34 patients, 17 were stage T1a and 17 T1b; 11 patients had a Gleason sum of 7-10, all of them in the T1b group. In the T1b group the mean age was 74 years, the mean PSA level 2.9 ng/ml and the mean weight of tissue resected 11.1 g. Corresponding values in the T1a patients were 70.1 years, 3.32 ng/ml and 18.2 g. Conclusions Compared to previous studies, we noticed a low incidence of "true" incidental prostatic carcinoma but a high ratio of poorly differentiated tumors (all stage T1b). Compared to the group as a whole, patients with incidental prostate cancer were older and had smaller prostate and transition zone volumes. Further research is needed to identify parameters that may aid in the earlier identification of incidental prostate cancer, as patients may benefit from curative treatment. [ABSTRACT FROM AUTHOR]

Focuses on renal haemangiopericytoma (HPC). Pulmonary metastases from HPC; Uncontrolled proliferation of pericytes.