Prospective Evaluation of Extracorporeal Shockwave Lithotripsy in Renal and Upper Ureteric Stone Treatment: Clinical Assessment and Results.

INTRODUCTION: Extracorporeal shockwave lithotripsy (ESWL) is a widely accepted non-invasive treatment for renal and upper ureteric stones smaller than 2 cm due to its safety and efficacy. Despite advancements in minimally invasive techniques, extracorporeal shockwave lithotripsy remains an important modality. AIMS AND OBJECTIVE: This prospective observational study aimed to evaluate the outcomes of ESWL in managing renal and upper ureteric stones measuring less than 2 cm in terms of stone clearance. MATERIAL AND METHODS: In a study conducted at a university-affiliated tertiary care hospital, 119 patients with renal and upper ureteric stones underwent extracorporeal shockwave lithotripsy over a 12-month period. Data on patient demographics, stone characteristics, treatment procedures, and complications were collected. Follow-up assessments were performed at two-week intervals for up to two months post-treatment. RESULTS: The mean age of patients was 39.78 years, with a mean stone size of 1.2 cm. Right kidney stones were more prevalent (61.3% [n=76]). Complications included fever (19.3% [n=23]), gross haematuria (24.3% [n=29]), and steinstrasse (21.8% [n=26]). The success rate of extracorporeal shockwave lithotripsy was 81.5% (n=97), with 18.5% (n=22) of patients requiring surgical intervention due to incomplete fragmentation or residual fragments >4 mm. Stone size and density played significant roles in treatment success. CONCLUSION: Despite advancements in minimally invasive techniques, ESWL retains its significance as a noninvasive and effective treatment option for renal and upper ureteric stones smaller than 2 cm. Its success depends on various factors, including the stone site, size, and composition. ESWL offers advantages such as minimal morbidity, shorter hospital stays, and better patient compliance. Complications such as steinstrasse are manageable with conservative measures or ancillary procedures. While ESWL may be losing ground in some cases, its noninvasive nature and favourable outcomes make it a valuable option in the armamentarium for stone management.

Miniperc: what is its current status?

PURPOSE OF REVIEW: To review the recently published literature related to miniperc. RECENT FINDINGS: Miniperc has generated lot of enthusiasm in the last few years. Miniperc utilizes tract size of 20 F or less, hence the complication rates are much less. Hematocrit drop is significantly reduced and blood transfusion rates have gone down. Reduced pain and hospital stay without affecting success rate is the remarkable achievement of this procedure. Although initially it was supposed to be for small sized stones, many authors have utilized miniperc even for large and complex stones with good clearance rate. SUMMARY: Miniperc has several advantages over standard percutaneous nephrolithotomy. In comparison with retrograde intrarenal surgery and shock wave lithotripsy, it offers better clearance rate. Hemorrhagic complications of miniperc are significantly less, making it an attractive procedure for treating renal stones.

Expression of CD10 in urothelial carcinoma of the bladder and its correlation with histopathological grade, pathological stage, and survival of patients.

BACKGROUND: CD10 plays a role in signal transduction pathway and regulation of cell growth apoptosis, and therefore, it has been evaluated in different malignancies. The present study was conducted to study the immunoexpression of CD10 in urothelial carcinoma and to correlate it with histological grade, pathological stage, and survival of patients. MATERIALS AND METHODS: The study included 51 cases of urothelial carcinoma diagnosed on histopathology along with 50 controls having nonneoplastic urothelium. All the cases and controls were subjected to CD10 immunostaining. The CD10 expression was compared between the cases and controls and was also correlated with histological grade, pathological stage, histomorphological features, and 1-year survival. RESULTS: The study included 78.4% of high-grade urothelial carcinoma (HGUC) and 21.6% of low-grade urothelial carcinoma. The positive score of CD10 expression was observed in 68.6% of cases, while 96% of controls observed negative immunostaining. About 90.9% of low-grade carcinoma observed score 0, while 83.7% of high grade observed positive score of 1 and 2. Although there was statistical significant difference between CD 10 score and stage of tumor, its expression did not correlate with 1-year survival of cases. CONCLUSION: CD10 expression increases with the grade of tumor and thus may be helpful in differentiating low grade from HGUC. Its expression also increases with stage and poor prognostic factors suggesting its possible role in pathogenesis and progression of urothelial carcinoma. CD 10 may be further analyzed for molecular targeted therapy against urothelial carcinoma.

Evaluation of Gastric Emptying by Ultrasonography after Recommended Fasting Period and Administration of Prokinetic in End-stage Renal Disease Patients.

BACKGROUND: Delayed gastric emptying is observed in end-stage renal disease (ESRD). AIMS: Evaluation of gastric emptying after recommended fasting period and on oral administration of prokinetic in ESRD patients using ultrasonography (USG). SETTINGS AND DESIGN: Randomized, double-blind, prospective, controlled study. MATERIALS AND METHODS: After institutional ethics committee approval, 200 patients were divided randomly into two equal groups. Three sessions of USG evaluation of gastric antrum were done in supine and right lateral position for assessing gastric emptying, first at 8 am, second after the light meal at 8.30 am, and third after 6 h of light meal. Group A received placebo (sugar-coated pill) and Group B received tablet metoclopramide hydrochloride 10 mg after second session of USG. In each session, measurement of anteroposterior and craniocaudal diameters of gastric antrum was done, and then cross-sectional area was estimated. Three-point grading system (Perlas) was used to perform qualitative evaluation. STATISTICAL ANALYSIS: Comparison of normally distributed continuous variables was performed using Student's t-test. Nominal categorical data were compared using Chi-squared test. Nonnormal distribution continuous variables were compared using Mann-Whitney U-test. RESULTS: 6 h of fasting after light meal showed that Group A only had 14% incidence of complete gastric emptying, whereas Group B had 71% as compared by Perlas grading. Gastric antral cross-sectional area measured both in supine (480.89 ± 84.92) and right lateral (575.40 ± 92.62) position of Group A was more than Group B supine (394.15 ± 62.80) and right lateral (470.25 ± 73.63) position (P < 0.05). CONCLUSION: USG of ESRD patients preoperatively can evaluate gastric contents to assess risk of pulmonary aspiration and guide anesthetic management. Metoclopramide is a good drug to enhance gastric emptying in ESRD patients within the recommended fasting period.