Diagnostic yield of fusion magnetic resonance-guided prostate biopsy versus cognitive-guided biopsy in biopsy-naive patients: a head-to-head randomized controlled trial.

BACKGROUND: The combination of MRI-guided targeted biopsy (MRGB) with systematic biopsy (SB) provides the highest accuracy in detecting prostate cancer. There is a controversy over the superiority of fusion targeted biopsy (fus-MRGB) over cognitive targeted biopsy (cog-MRGB). The present head-to-head randomized controlled trial was performed to compare diagnostic yield of fus-MRGB in combination with SB with cog-MRGB in combination with SB. METHODS: Biopsy-naive patients with a prostate-specific antigen level between 2 and 10 ng/dL who were candidates for prostate biopsy were included in the study. Multiparametric MRI was performed on all patients and patients with suspicious lesions with Prostate Imaging Reporting and Data System score of 3 or more were randomized into two groups. In the cog-MRGB group, a targeted cognitive biopsy was performed followed by a 12-core SB. Similarly, in the fus-MRGB group, first targeted fusion biopsy and then SBs were performed. The overall and clinically significant prostate cancer detection rates between the two study groups were compared by the Pearson χ2 test. McNemar test was used to compare detection rates yielded by SB and targeted biopsy in each study group. RESULTS: One-hundred men in the cog-MRGB group and 99 men in the fus-MRGB group were compared. The baseline characteristics of patients including age, PSA level, prostate volume, PSA density, and clinical stage were similar in the two groups (p > 0.05). Both the overall and clinically significant prostate cancer detection rates in the fus-MRGB group (44.4% and 33.3%, respectively) were significantly higher than cog-MRGB group (31.0% and 19.0%, respectively) (p = 0.035 and p = 0.016, respectively). CONCLUSION: The accuracy of identifying overall and clinically significant prostate cancer by fus-MRGB in biopsy-naive patients with PSA levels between 2 and 10 ng/dL is significantly higher than cog-MRGB and if available, we recommend using fus-MRGB over cog-MRGB in these patients.

Percutaneous nephrolithotomy in patients with previous open nephrolithotomy: one-shot versus telescopic technique for tract dilatation.

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy (PCNL) can be done in patients who have previously had open nephrolithotomy. Currently, dilatation of the nephrostomy tract is achieved using an Amplatz renal dilator or telescopic metal dilators in these patients. The aim of this study was to compare the safety and efficacy of the "one-shot" procedure in patients with previous open nephrolithotomy with those of the current telescopic technique. PATIENTS AND METHODS: Thirty-one patients with past history of open surgery for kidney stone disease underwent PCNL at our institution from February 2006 to March 2007. Patients were randomly divided into two groups according to dilation technique used: group A (telescopic procedure) and group B (one-shot procedure). X-ray exposure, blood loss, and complications were evaluated. RESULTS: No significant difference in hemoglobin decrease was seen in the two groups. The stone-free and complication rates were the same in the two groups. Fluoroscopy time during the one-shot procedure was significantly shorter than that of the telescopic procedure (P < 0.000). CONCLUSION: Our experience indicated that the one-shot procedure is feasible in patients with previous open nephrolithotomy. It is as safe and effective as the telescopic procedure, with significant reduction in x-ray exposure.

Comparison of the effect of body position, prone or supine, on the result of extracorpreal shock wave lithotripsy in patients with stones in the proximal ureter.

The aim of this study was to determine whether positioning of the patient, prone or supine, plays a significant role on the treatment of stones in the proximal ureter with extracorporeal shock wave lithotripsy (ESWL). 68 patients with proximal ureteric stones underwent ESWL. The procedure was performed in the supine position in 35 (Group 1) and the prone position in 33 patients (Group 2). Stone-free rates, repeat ESWL rates, shocks per patient and shocks per session were compared in both groups. The mean session number per patient was 1.93 +/- 0.82 in Group 1 and 1.88 +/- 0.79 in Group 2 (P = 0.786). The stone-free rates, three months after ESWL, were 81.8% in Group 1 and 82.9% in Group 2 (P = or > 0.05). Thus, these two parameters were similar in both Groups. Also, the number of shocks per session was 3066.1 +/- 346.3 in Group 1 and 3148.5 +/- 621.0 in Group 2. This difference was nonsignificant (P = 0.49). Our study suggests that the treatment of proximal ureteric stones with ESWL in the prone position is as safe and effective as when the patient is placed in the supine position.

Extracorporeal shock wave lithotripsy in prone and supine positions for patients with upper ureteral calculi.

INTRODUCTION: The aim of this study was to evaluate the treatment of upper ureteral calculi with extracorporeal shock wave lithotripsy (SWL) in the supine and prone positions. MATERIALS AND METHODS: A total of 68 patients with upper ureteral calculi underwent SWL. In 35 patients, the procedure was performed in the supine position (group 1), while in the 33 remainders, it was performed in the prone position (group 2). The stone-free rate, the number of SWL sessions required, and the number of shocks per treatment session were compared between the 2 groups. RESULTS: The mean calculus size was 12.4 +/- 3.1 mm and 12.2 +/- 2.9 mm in groups 1 and 2, respectively. The stone-free rate was 81.8% in group 1 and 82.9% in group 2 (P = .91). The number of sessions for achieving the stone-free status was similar in the patients of the 2 groups (1.9 +/- 0.8 in group 1 versus 1.9 +/- 0.8 in group 2; P = .79). The mean number of shock waves per treatment session was not significantly different between the 2 groups. No major complications were seen and none of the patients required hospitalization, placement of a ureteral catheter, or a double-J stent. CONCLUSION: Our study showed that in the prone position, treatment of the upper ureteral calculi by SWL is as safe and effective as the supine position.