Her-2/neu expression in prostate adenocarcinoma: a systematic review and meta-analysis.

PURPOSE: HER-2/neu has been linked to the clinical progression of hormone independent prostate cancer. We performed a meta-analysis to investigate the prognostic impact of HER-2/neu over expression in patients with prostate adenocarcinoma, and its correlation with other pathological and clinical variables. MATERIALS AND METHODS: We searched the MEDLINE, Embase, CancerLit and ASCO abstract databases for published studies of HER-2/neu protein expression in primary prostate cancer tissue with a median followup of greater than 2 years and data on survival in patients with and without HER-2/neu over expression. We separately analyzed studies reporting HER-2/neu soluble receptor levels in patients with prostate cancer. RESULTS: We included 38 articles with a total of 5,976 patients. The overall RR of death in those with HER-2/neu over expression in the primary tumor was 1.63 (95% CI 1.47-1.82, p <0.0001). In the presence of over expression the recurrence RR was 1.87 (95% CI 1.59-2.21, p <0.0001). High HER-2/neu extracellular domain levels also correlated with death (RR 2.01, 95% CI 1.21-3.35, p = 0.007) and recurrence (RR 1.74, 95% CI 1.41-2.15, p <0.0001). CONCLUSIONS: There is a consistent association of HER-2/neu over expression and Gleason less than 7 with a higher RR of death and recurrence in patients with prostate cancer. Further clinical trials should test the hypothesis that HER-2/neu is a marker of a clinically worse outcome in patients with prostate cancer and a potential target for therapy.

[Laparoscopic adrenalectomy: a prospective study comparing transperitoneal and retroperitoneal approaches]. / Estudo comparativo entre supra-renalectomia laparoscópica pelos acessos transperitoneal e retroperitoneal.

OBJECTIVES: A prospective protocol was used to compare transperitoneal and retroperitoneal laparoscopic access for treatment of adrenal lesions. METHODS: Forty patients (19 male and 21 female) were submitted to laparoscopic adrenalectomy. Patients were operated by two surgeons. Twenty cases for each type of access (transperitoneal and retroperitoneal) were selected for analysis. Operative time, blood loss, time to oral intake, dose of analgesic, surgical complications, conversions, hospital stay and return to normal activities were compared for both approaches. RESULTS: All procedures were successfully completed. Operative mean time and time to oral intake were 3.6 h and 24 h for the transperitoneal and 2.5 h and 12 h for the retroperitoneal approach (p<0.05). There were no differences in blood loss, analgesia, hospital stay and time for return to normal activities. Complications were observed in two patients in the transperitoneal approach (retroperitoneal bleeding and pancreatitis) and there were three events in the retroperitoneal approach (hipercarbia, peritoneal laceration and pneumonia). No conversions occurred in this cohort of patients. CONCLUSION: Laparoscopic adrenalectomy is a safe and efficient treatment for an adrenal mass of up to 10 cm. There are no relevant differences between the transperitoneal and retroperitoneal approach. Choice of the laparoscopic approach rests upon particular aspects of each case or upon the surgeon's preference.

Hand-assisted bilateral nephrectomy in a patient with adult polycystic kidney disease.

CONTEXT: Dominantly autosomal polycystic disease is characterized by multiple bilateral and non-functional cysts, which lead to progressive kidney failure. OBJECTIVE: Our objective was to report on a case of hand-assisted bilateral nephrectomy in a 28-year-old female patient with adult polycystic disease and recurring pyelonephritis in a kidney transplant program. CASE REPORT: A hand-assisted bilateral nephrectomy was performed through a supra-umbilical median incision of approximately 6 cm, and with 3 ports of 10 mm. The length of the surgery was 3 hours and 15 minutes. The kidneys were removed after the aspiration of some cysts through the supra-umbilical incision. Pain control was achieved via the use of analgesics. The blood loss during surgery was 160 ml. During the postoperative period, the patient developed right-side pneumothorax, which was drained with no further occurrence. This drain was kept in place for 48 hours. The length of hospitalization was 4 days.

Retroperitoneoscopic adrenalectomy in an infant with adrenocortical virilizing tumor.

CONTEXT: Adrenocortical virilizing tumors are rare in the pediatric age group. Laparoscopic surgery is the gold standard method for treatment of adrenal functional tumors under 6 cm in size, in adults. There has been very little use of laparoscopy in children and there is no report of its application in the treatment of adrenal carcinoma in childhood. DESIGN: Case report. CASE REPORT: We performed the first laparoscopic resection using retroperitoneal access for the treatment of an adrenocortical virilizing tumor in a pediatric patient. We believe that retroperitoneoscopic access is a viable and promising option for the treatment of adrenal tumors in children.

Cardiovascular and metabolic syndrome risk among men with and without erectile dysfunction: case-control study.

CONTEXT AND OBJECTIVE: Erectile dysfunction has been associated with cardiovascular diseases. The aim here was to evaluate cardiovascular risk through the Framingham Risk Score (FRS) criteria, C-reactive protein (CRP) assays and presence of metabolic syndrome (MS) in men with and without erectile dysfunction diagnosed within a healthcare program. DESIGN AND SETTING: A retrospective case-control study was conducted. The patients were selected from a healthcare program at the Hospital Israelita Albert Einstein, between January and December 2007. METHODS: 222 men were retrospectively selected, and they were divided into two groups: men with erectile dysfunction (n = 111) and men without erectile dysfunction (n = 111). The patients were stratified according to the International Index of Erectile Function-Erectile Function domain (IIEF-EF domain). CRP and FRS were analyzed and the two groups were compared. RESULTS: The CRP levels were significantly higher among men with erectile dysfunction (P = 0.04). Patients with erectile dysfunction also had high FRS (P = 0.0015). CRP and FRS did not correlate with the severity of erectile dysfunction. The presence of metabolic syndrome was greater among men with erectile dysfunction (P < 0.05). The severity of erectile dysfunction was directly associated with metabolic syndrome. CONCLUSION: Men with erectile dysfunction presented higher cardiovascular risk according to the FRS criteria and CRP measurements. Severe erectile dysfunction seemed to have a correlation with metabolic syndrome.

Robotic assisted radical prostatectomy: a different treatment for prostate cancer?

Considering the Health Care System in Brazil, a developing country, and public healthcare policies, robotic surgery is a reality to very few citizens. Therefore, robotic assisted radical prostatectomy is far removed from the daily practice of the vast majority of Brazilian urologists. Scientific evidence of the superiority of robotic assisted radical prostatectomy does not presently justify public investments for widespread development of robotic centers. Maybe over time and with reductions in costs, robotic technology will become a more established practice, as observed in other countries, and more feasible for the Brazilian urological community.

Male infertility related to an aberrant karyotype, 46,XY,9ph,9qh+.

OBJECTIVE: To report a man with primary infertility and variant karyotype. DESIGN: Case report. SETTING: Private practice. PATIENT(S): A 37-year-old man with 4 years of primary infertility due to oligoasthenozoospermia. INTERVENTION(S): None. MAIN OUTCOME MEASURE(S): G- and C-banding. Polymerase chain reaction for SRY, DBY, RBMY, DAZ, AMELX, and AMELY. RESULT(S): G-band analysis of the proband revealed a 46,XY,9ph,9qh+ karyotype. C-banding confirmed increase in the heterochromatin in one chromosome 9 and inversion in the other. CONCLUSION(S): The morphologic difference between the homologous chromosomes 9 may have been responsible for an error in crossing-over, leading to aberrant spermatozoa and consequently to infertility.

Video-assisted colonic conduit: a new minimally invasive urinary diversion to patients after pelvic radiotherapy.

PURPOSE: To report preliminary results of the first case of video-assisted colonic conduit. A 42-year-old woman had undergone external beam radiotherapy for squamous cell carcinoma of the cervix and developed a vesicovaginal fistula with small capacity bladder. Intraoperative option for urinary diversion was colonic conduit. METHODS: A 4 trocar transperitoneal approach was chosen and isolation of both ureters was performed. A 5 cm incision between xiphoid and umbilicus was carried out. A 15 cm colonic segment was isolated with linear stapler maintaining blood supply. Intestinal transit was then reconstructed. Leadbetter ureterointestinal anastomoses were performed with ureteral splints. Drainage, colostomy maturation, and closure of incisions were carried out conventionally. RESULTS: Operative time was 195 minutes; blood loss was 90 mL; no intraoperative or postoperative complications were observed. Length of hospital stay was 7 days and time to full recovery 3 weeks. CONCLUSIONS: Video-assisted colonic conduit is feasible and have promising results concerning reduction of surgical morbidity.

Comparative results of two techniques to treat stress urinary incontinence: synthetic transobturator and aponeurotic slings.

INTRODUCTION AND HYPOTHESIS: This study aims to analyze comparatively the efficacy and safety of synthetic transobturatory and aponeurotic retropubic slings, in the treatment of stress urinary incontinence (SUI) in women. METHODS: Patients were separated in a randomized way. Twenty-one patients were submitted to the operatory correction by the transobturatory sling technique, whereas 20 patients were operated by the retropubic sling technique. All patients were submitted to complete physical exam and urodynamic test. The "T" test and the Mann-Whitney U test were applied to establish comparisons between the two groups. Patients were followed-up for 12 months. RESULTS: Healing rate was 90.5% (19/21) and 95% (19/20), respectively after 12 months. The transobturatory group presented lesser complications rate than the retropubic group. CONCLUSIONS: The transobturatory and the aponeurotic slings techniques were equally effective for the treatment of SUI. The transobturatory sling has shown fewer complications and lesser surgical time than the aponeurotic sling technique.

Extensive ureteral stricture after percutaneous nephrolithotomy.

OBJECTIVE: To present a previously unreported long term complication of percutaneous nephrolithotomy for exclusive renal stone. METHODS/RESULTS: A 30-years-old woman underwent percutaneous nephrolithotomy for a obstructive pelvic stone, through inferior calix access achieving a stone free status. During the procedure occurred an inadvertent pelvis perforation, but the early evolution was otherwise uneventful. Patient was asymptomatic during the follow-up. However, a urinary ultrasound disclosed important pielocalyceal dilation, and further investigation demonstrated extensive proximal ureteral stricture. CONCLUSION: Ureteral stricture may rarely occur as a late complication of percutaneous nephrolithotomy. A review of the literature of this quite uncommon complication was performed and the authors discuss the possible etiology and preventive measures.

Can video endoscopic inguinal lymphadenectomy achieve a lower morbidity than open lymph node dissection in penile cancer patients?

BACKGROUND AND PURPOSE: Radical lymphadenectomy improves survival in penile cancer patients, but the morbidity of the classic open procedure exceeds 50%. We report the updated results of Video Endoscopic Inguinal Lymphadenectomy (VEIL), an original minimally invasive procedure recently reported for extended inguinal node dissection in clinical settings. PATIENTS AND METHODS: Fifteen consecutive patients who underwent the VEIL technique were prospectively followed and included in this study. The first 10 patients underwent bilateral inguinal dissection for nonpalpable lymph nodes: VEIL at one side and standard open lymph node dissection at the other side. A second cohort consisted of five patients who underwent bilateral VEIL, either for nonpalpable or for palpable (N1) inguinal nodes. Operative data and postoperative outcomes were assessed, and VEIL and the open technique were compared. RESULTS: Twenty limbs underwent VEIL and 10 limbs underwent the open procedure. Mean operative time was 120 minutes for VEIL and 92 minutes for the open procedure. There was no difference in the number of nodes removed or in the positivity for metastatic lymph nodes. Complications were observed in 70% of limbs that underwent open surgery and in 20% of limbs that underwent VEIL (P 0.015). Patients who underwent a bilateral VEIL could be discharged from the hospital after an average of 24 hours (range 12-36 hrs), while patients who underwent an open dissection in addition to contralateral VEIL were discharged after an average of 6.4 days (range 5-10 d) There were no recurrences detected during a mean follow-up of 31.9 months (median 33 months). CONCLUSION: This preliminary series suggests that VEIL can reduce morbidity, including hospitalization times,compared with standard open surgery. Oncologic results are premature but seem similar to the results from the conventional open operation. VEIL is a promising minimally invasive approach for radical inguinal dissection in penile cancer patients with nonpalpable or low-volume palpable inguinal disease.

Video endoscopic inguinal lymphadenectomy: a new minimally invasive procedure for radical management of inguinal nodes in patients with penile squamous cell carcinoma.

PURPOSE: Video endoscopic inguinal lymphadenectomy is a recently described lymphadenectomy with the same template of the open technique but performed with laparoscopic instruments under video guidance. It was developed to decrease procedure related morbidity while maintaining good oncological results. We report our initial results in a trial comparing video endoscopic inguinal lymphadenectomy with standard inguinal lymphadenectomy. MATERIALS AND METHODS: From 2003 to 2005, 10 patients with penile carcinoma who were at high risk for inguinal metastases underwent bilateral inguinal lymphadenectomy. We performed standard lymphadenectomy in 1 limb and video endoscopic inguinal lymphadenectomy on the contralateral side. Perioperative results and followup data were compared. RESULTS: No intraoperative complications occurred. Mean operative time was 92 and 126 minutes for open and endoscopic surgery, respectively (p=0.00002). Despite the small number of patients we noted a decrease in cutaneous complications with video endoscopic inguinal lymphadenectomy (0% vs 50%, p=0.017) and a trend toward decreased overall morbidity with this endoscopic technique (20% vs 70%, p=0.059). The mean number of retrieved and positive lymph nodes were similar for the 2 techniques. At a mean followup of 18.7 months (range 12 to 31) no signs of recurrence or disease progression were noted. In the postoperative period 9 of the 10 patients identified video endoscopic inguinal lymphadenectomy as the preferred technique in terms of surgical morbidity. CONCLUSIONS: Video endoscopic inguinal lymphadenectomy is a safe and feasible technique in patients with penile carcinoma and nonpalpable nodes. These preliminary results suggest that video endoscopic inguinal lymphadenectomy may decrease postoperative morbidity without compromising oncological control. Future studies should include the bilateral procedure, longer term followup and a greater number of patients.

Vesical explosion during transurethral resection of the prostate: report of a case.

OBJECTIVE: Vesical perforation during transurethral resection of the prostate (TURP) is usually related to high increases in intravesical pressure. However, it may rarely be related to explosion precipitated by the contact of the electrocautery with some gases produced during the resections. The authors present a case of vesical explosion, discuss its mechanism and suggest some measures for prevention. METHODS/RESULTS: A 71-years-old male underwent TURP and hemostasy of bleeding from the bladder neck due to persistent hematuria. A wire loop electrode set at a cutting and coagulating current of 80 watts was used. During coagulation of a bleeding in the anterior aspect of the vesical neck when the bladder was empty, a loud pop was heard and a jolt was felt at the lower abdomen. Inspection revealed a hole in the dome of the bladder with loops of small bowel visible. A low midline incision was done, and the intraperitoneal bladder rupture was repaired. CONCLUSION: Although uncommon, vesical explosion during TURP may occur and some preventive measures, discussed herein, can be performed to avoid this complication.

[Laparoscopic retroperitoneal adrenalectomy as a minimally invasive option for the treatment of adrenal tumors]. / Suprarrenalectomía laparoscópica retroperitoneal como opción minimamente invasiva en el tratamiento de tumores adrenales.

OBJECTIVES: The excision of the adrenal gland by laparoscopic approach is the gold standard for the treatment of adrenal tumors smaller than 6 cm. Most Brazilian centres favour the transperitoneal approach. The objective of the present prospective study was to show the intraoperative and postoperative results of patients undergoing adrenal laparoscopic surgery through a lateral retroperitoneal approach performed by an individual surgeon. METHODS: Between January 2000 and October 2004, 35 patients (16 males and 19 females) with adrenal lesions, including 4 Cushing's syndrome, 4 Conn's syndrome, 1 neuroganglioma, 4 pheochromocytoma, 17 nonfunctioning adenomas, 1 virilizing tumor, and 4 cases of adrenal nodule after treatment of a non-adrenal primary neoplasia, prospectively underwent retroperitoneoscopic adenomectomy by one surgeon. We describe surgical times, estimated blood losses, time to oral intake, analgesic requirements, surgical complications and conversion rates, hospital stay and time to return to usual activities, comparing our results with other series in the literature. RESULTS: All procedures were successfully completed. Mean surgical time was 135 minutes, mean estimated blood loss 235 ml, mean time to oral intake 12 hours, no patient required analgesics after the second postoperative day, mean hospital stay was 2 days, and mean time to return to usual life activities 3 weeks. There were two complications, one case of intraoperative hypercapnia and one case with postoperative pneumonia. Conversion to open surgery was not required in any case. CONCLUSIONS: Retroperitoneoscopic adrenalectomy may be performed effectively and safely, with a low complication rate, independently of the etiology of the lesion. The lateral retroperitoneoscopic access is an excellent option for the minimally invasive treatment of the adrenal glands.

Nefrostomia percutânea guiada por ultrassom: opção minimamenteinvasiva de acesso ao rim:[revisão] / Percutaneous nephrostomy guided by ultrasound: minimum invasive option of kidney access: [review]

A nefrostomia percutânea guiada por ultrassom é uma técnica de derivação urinária alta para pacientes com obstrução ureteral bilateral e uremiapós-renal. Este procedimento é mais frequentemente direcionado através de imagem radioscópica. Tivemos por objetivo descrever nossa técnica denefrostomia guiada por imagem ultrassonográfica como opção menos invasiva aprimorada após cinco anos de experiência. Paciente em pronação,administração de medicação pré-anestésica, inspeção ultrassonográfica com visão longitudinal do rim para localização do sistema coletor dilatado, demaneira que todo o rim seja visualizado na tela, demarcação na pele do local de punção adjacente ao probe no seu ponto médio. Realizou-se antissepsia,anestesia local com lidocaína, punção com agulha de Chiba sob visão do ultrassom no ponto demarcado com angulação de 15-30º com relação àimagem do probe no sentido de penetrar um cálice dilatado, observação ultrassonográfica da agulha dentro do sistema coletor, colocação fio-guia edilatadores e, por fim, cateter de polietileno com fixação à pele e conexão à bolsa coletora. A aplicação desta técnica com passos padronizados semostrou simples e rápida, de pronta aplicabilidade pelo urologista na prática diária, com baixo índice de complicações e com alto índice de sucesso.

Percutaneous nephrostomy guided by ultrasound is a high urinary derivation technique in post renal uremia and bilateral ureteral obstruction patients.This procedure is often guided by radioscopic imaging. Our goal is to describe our ultrasonographic guided nephrostomy method as a less invasive optionimproved in 5-year experience. Patients in prone position, infusion of pre-anestesic medication and ultrasonographic longitudinal kidney view to identifythe expanded collector system in a way that the entire kidney can be seen on screen. After antisepsis and asepsis, local anesthesia with lidocaineChiba?s needle punction under ultrasound view of pre-defined point in 15-30º angulation according to the probe image to penetrate a dilated collectingsystem, ultrasonographic view of the needle inside the collecting system, placement of the lead and dilators and then fix the polyethylene catheter tothe skin connected to a collecting bag. The use of this technique with standardized steps has been shown simple and fast, immediately applicable by the urologist with low complication and high success index.

Cardiovascular and metabolic syndrome risk among men with and without erectile dysfunction: case-control study / Risco cardiovascular e da síndrome metabólica entre homens com e sem disfunção erétil: estudo caso controle

CONTEXT AND OBJECTIVE: Erectile dysfunction has been associated with cardiovascular diseases. The aim here was to evaluate cardiovascular risk through the Framingham Risk Score (FRS) criteria, C-reactive protein (CRP) assays and presence of metabolic syndrome (MS) in men with and without erectile dysfunction diagnosed within a healthcare program. DESIGN AND SETTING: A retrospective case-control study was conducted. The patients were selected from a healthcare program at the Hospital Israelita Albert Einstein, between January and December 2007. METHODS: 222 men were retrospectively selected, and they were divided into two groups: men with erectile dysfunction (n = 111) and men without erectile dysfunction (n = 111). The patients were stratified according to the International Index of Erectile Function-Erectile Function domain (IIEF-EF domain). CRP and FRS were analyzed and the two groups were compared. RESULTS: The CRP levels were significantly higher among men with erectile dysfunction (P = 0.04). Patients with erectile dysfunction also had high FRS (P = 0.0015). CRP and FRS did not correlate with the severity of erectile dysfunction. The presence of metabolic syndrome was greater among men with erectile dysfunction (P < 0.05). The severity of erectile dysfunction was directly associated with metabolic syndrome. CONCLUSION: Men with erectile dysfunction presented higher cardiovascular risk according to the FRS criteria and CRP measurements. Severe erectile dysfunction seemed to have a correlation with metabolic syndrome.

CONTEXTO E OBJETIVO: Disfunção erétil está associada a doenças cardiovasculares. O objetivo foi avaliar o risco cardiovascular através dos critérios de Framingham (FRS), da dosagem de proteína C-reativa e da presença de síndrome metabólica em homens com e sem disfunção erétil diagnosticados em um programa de saúde. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo tipo caso-controle foi realizado. Os pacientes foram selecionados de um programa de saúde do Hospital Israelita Albert Einstein, no período de janeiro a dezembro de 2007. MÉTODOS: 222 homens foram retrospectivamente selecionados e divididos em dois grupos: homens com disfunção erétil (n = 111) e homens sem disfunção erétil (n = 111). Os pacientes foram estratificados de acordo com o Índice Internacional de Disfunção Erétil (International Index of Erectile Function, Erectile Function domain, IIEF-EF domain). A proteína C-reativa e o escore de Framingham foram analisados e os dois grupos foram comparados. RESULTADOS: O nível da proteína C foi significativamente maior entre homens com disfunção erétil (P = 0,04). Pacientes com disfunção erétil também tinham um escore de risco de Framingham alto (P = 0,0015). A proteína C e o escore de Framingham não se correlacionaram com o grau de gravidade da disfunção erétil. A presença de síndrome metabólica foi maior nos pacientes com disfunção erétil (P < 0,05). A gravidade da disfunção erétil esteve diretamente associada com a síndrome metabólica. CONCLUSÃO: Homens com disfunção erétil apresentaram maior risco cardiovascular de acordo com os critérios de Framingham e pela mensuração da proteína C-reativa. A disfunção erétil grave em homens parece ter correlação com a síndrome metabólica.

Robotic assisted radical prostatectomy: a different treatment for prostate cancer? / Prostatectomia radical robô-assistida: um tratamento diferente para câncer de próstata?

Considering the Health Care System in Brazil, a developing country, and public healthcare policies, robotic surgery is a reality to very few citizens. Therefore, robotic assisted radical prostatectomy is far removed from the daily practice of the vast majority of Brazilian urologists. Scientific evidence of the superiority of robotic assisted radical prostatectomy does not presently justify public investments for widespread development of robotic centers. Maybe over time and with reductions in costs, robotic technology will become a more established practice, as observed in other countries, and more feasible for the Brazilian urological community.

Levando em conta o Sistema de Saúde do Brasil, um país em desenvolvimento, e as políticas de saúde pública, a cirurgia robótica é uma realidade disponível a poucos cidadãos. Assim, a prostatectomia radical robô-assistida está longe da prática diária da grande maioria dos urologistas brasileiros. As evidências científicas da superioridade da prostatectomia radical assistida por robôs não justificam, no momento, os investimentos públicos para o desenvolvimento disseminado de centros de robótica. Talvez mais tarde e com redução nos custos, a tecnologia da robótica torne-se uma prática mais estabelecida, como já observado em outros países, e fique, assim, mais viável para a comunidade urológica do Brasil.

Prostate innervation and local anesthesia in prostate procedures.

The nerve supply of the human prostate is very abundant, and knowledge of the anatomy contributes to successful administration of local anesthesia. However, the exact anatomy of extrinsic neuronal cell bodies of the autonomic and sensory innervation of the prostate is not clear, except in other animals. Branches of pelvic ganglia composed of pelvic (parasympathetic) and hypogastric (sympathetic) nerves innervate the prostate. The autonomic nervous system plays an important role in the growth, maturation, and secretory function of this gland. Prostate procedures under local anesthesia, such as transurethral prostatic resections or transrectal ultrasound-guided prostatic biopsy, are safe, simple, and effective. Local anesthesia can be feasible for many special conditions including uncomplicated prostate surgery and may be particularly useful for the high-risk group of patients for whom inhalation or spinal anesthesia is inadvisable.

Ureterolithotripsy in the management of calcified double-J catheter.

OBJECTIVE: The authors present their experience in the management of a rare complication observed during long-term use of a ureteral catheter. The calcification along the entire surface of the catheter followed by incrustation can make its removal by means of cystoscopy difficult, thus becoming a great challenge to the urologist. METHODS: The authors describe their experience in the management of this complication through the analysis of two illustrative cases. RESULTS: After failing to remove the catheter using extracorporeal lithotripsy, ureterolithotripsy was performed and the calcified ureteral catheter was successfully removed in both cases. CONCLUSION: Ureterolithotripsy proved to be an effective and safe method in the management of calcified double-J catheter.