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The experience at this institution with tubeless percutaneous nephrostolithotomy was reviewed to determine its safety and efficacy. Between April 1997 and June 1998, 33 "tubeless" percutaneous nephrostolithotomies were performed. All procedures were performed by a single surgeon (R.W.W). All patients had an internal ureteral stent placed at the time of surgery, and a Foley catheter remained in place overnight. All patients had their nephrostomy tube removed in the OR at the end of their surgery. The length of hospitalization, operative time, patients' comorbid conditions, pre- and postoperative hematocrits, transfusion requirements, reasons for a stay of longer than 24 h, complications, stone burdens treated, residual stone disease, any additional procedures required, and postoperative analgesia requirements were reviewed. All 33 percutaneous procedures were performed without significant complication. No transfusion was required. The average length of hospital stay was 1.5 days, with two-thirds of patients staying less than 24 h. A 94% stone-free rate was achieved, and patients had minimal analgesia requirements. This experience with the "tubeless" percutaneous nephrostolithotomy indicates that it is a safe and effective means of stone management. It will likely have an expanding role in the treatment of stone disease and other urologic problems of the upper urinary tract.

Purpose: Cryosurgical ablation of the prostate has recently become recognized as a therapeutic option in the treatment of localized adenocarcinoma of the prostate. To assess the efficacy of cryoablation in this disease process several centers have instituted treatment protocols., Materials and Methods: Our overall series includes 117 ultrasound guided percutaneous transperineal cryoablations performed on 104 patients with localized adenocarcinoma of the prostate. Followup consisted of digital rectal examinations and measurement of prostate specific antigen levels at 3-month intervals after cryosurgery. Additionally, prostate biopsies were obtained 3 to 6 months postoperatively., Results: Of 63 patients who underwent initial cryosurgery and followup biopsy 47 (75%) had negative findings. Of the 16 patients with positive biopsies 10 consented to undergo a second cryosurgical ablation, and 7 of these patients subsequently had negative followup biopsies. Therefore, our disease-free rate at 3 months after 1 or 2 cryosurgical procedures was 95%. A total of 46 protocol patients in our series completed 12 months of evaluation and 40 (87%) had no evidence of disease. This same cohort showed only minimal disease progression, with disease-free rates of 96, 93, 87 and 87% at 3, 6, 9 and 12 months, respectively. Major complications were infrequent., Conclusions: At 1-year followup our clinical experience shows cryoablation of the prostate to be an effective therapy in select cases of prostatic adenocarcinoma. Long-term efficacy is still in question but, based on current disease-free rates, this therepeutic modality merits continued clinical investigation.