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Objective: The supine position is becoming increasingly popular in percutaneous nephrolithotomy (PNL). Renal puncture is the key step for a successful PNL procedure. The aim of this study was to describe a novel method for renal puncture and compare it with a previously described method., Material and Methods: Data of 358 patients who underwent PNL in the supine position were collected prospectively. In 165 patients, the puncture was performed by a previously described method (Group 1), and in 193 patients, the puncture was performed with the novel method (Group 2). Groups were compared with regard to total time and fluoroscopy time to successful puncture. In the novel puncture technique, the needle is advanced toward the targeted calyx under monoplane fluoroscopy. To determine the needle depth, the C-arm is rotated by 10°. If the needle projection is beyond the targeted calyx in fluoroscopy, the puncture is deeper than desired. If the needle projection does not reach the targeted calyx, the puncture is more superficial than desired., Results: Groups were similar with regard to the mean age, gender distribution, body mass index, stone size, and site of puncture. The mean total time to puncture was 88.2±25.3 seconds in Group 1 and 54.3±22.3 seconds in Group 2, and the difference was statistically significant (p=0.03). The mean fluoroscopy time to puncture was 16.1±5.3 seconds in Group 1 and 9.3±3.4 seconds in Group 2, and the difference was statistically significant (p=0.03)., Conclusion: This novel method to determine the depth of the needle is simple, reproducible, and has the potential to diminish radiation exposure with the aid of intermittent fluoroscopy.

Purpose: To evaluate the outcomes of rigid ureterorenoscopy (URS) for renal pelvic stones (RPS) sized 1 to 2 cm and to determine the predictive factors for the requirement for flexible URS (F-URS) when rigid URS fails., Materials and Methods: A total of 88 patients were included into the study. In 48 patients, the RPS were totally fragmented with rigid URS and F-URS was not required (group 1). In 40 patients, rigid URS was not able to access the renal pelvis or fragmentation of the stones was not completed owing to stone position or displacement and F-URS was utilized for retrograde intrarenal surgery (RIRS) (group 2). The predictive factors for F-URS requirement during RIRS for RPS were evaluated. Both groups were compared regarding age, height, sex, body mass index, stone size, stone opacity, hydronephrosis, and previous treatments., Results: The mean patient age was 48.6±16.5 years and the mean follow-period was 39±11.5 weeks. The overall stone-free rate in the study population was 85% (75 patients). In groups 1 and 2, the overall stone-free rates were 83% (40 patients) and 87% (35 patients), respectively (p>0.05). The independent predictors of requirement for F-URS during RIRS were male gender, patient height, and higher degree of hydronephrosis., Conclusions: Rigid URS can be utilized in selected patients for the fragmentation of RPS sized 1 to 2 cm with outcomes similar to that of F-URS. In case of failure of rigid URS, F-URS can be performed successfully in this group of patients.

Purpose: To evaluate the influence of perinephric fat infiltration and tumor size on survival of patients with renal cell carcinoma (RCC)., Materials and Methods: We have retrospectively reviewed the records of 338 consecutive patients with pT1-3aN0M0 RCC, including 275 pT1-2 and 63 pT3a tumors, who underwent open partial or radical nephrectomy between 1995 and 2008. Univariate and multivariate analyses were performed in order to evaluate the prognostic factors., Results: Median follow-up period was 36.07 months. Receiver Operating Characteristic curve analysis determined the optimal tumor size cutoff value as 7 cm (Area Under the Curve: 0.65 ± 0.047; 95% Confidence Interval: 0.558 to 0.741). Perinephric fat invasion and Fuhrman grade were independent prognostic factors for disease-specific survival (DSS). In patients with tumor size >7 cm, perinephric fat invasion affected DSS significantly. Tumor size (according to the cutoff value of 7 cm) significantly affected DSS in patients with pT3a disease. According to the TNM 2002 staging system, perinephric fat invasion did not have any significant effect on DSS in patients with tumor size smaller than 4 cm, unlike tumor size of 4 to 7 cm and >7 cm. pT3a tumors larger than 7 cm demonstrated the worst prognosis compared to other groups., Conclusion: Perinephric fat invasion was demonstrated as a significant prognostic factor for RCC patients with tumor size >4 cm. Consequently, evaluation of pT3a patients should take tumor size into consideration for better prognostic analysis.

We report a 44-year-old woman with a malignant fibrous histiocytoma (MFH) of the kidney. Primary renal MFH is an extremely rare tumor with a poor prognosis. Renal MFH is differentiated from renal cell carcinoma, renal sarcoma, and sarcomatoid renal tumors only by histological and immunohistochemical studies. Because the therapeutic options for MFH are different, its early diagnosis is imperative.

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.