Is retrograde intrarenal surgery replacing percutaneous nephrolithotomy as surgical treatment of stone disease: Our clinical experience.

OBJECTIVE: Urolithiasis prevalence is 2-20% according to different geographic characteristics in different populations. In this study, we aimed to present the distribution of operation numbers for both percutaneous nephrolithotomy (PCNL) and retrograde intrarenal surgery (RIRS) in terms of age and stone size in order to reveal the changes over the years. METHOD: Between January 2010 and March 2016, 1814 patients were operated for the treatment of renal stones. Patients were directed to the two different operations according to the surgeons' choices: RIRS or PCNL. Prospectively collected data was retrospectively reviewed. RESULTS: In the years 2010, 2011, 2012, 2013, 2014, 2015, and 2016, the number of RIRS applied for the treatment of renal stones was 25, 87, 96, 147, 166, 174, and 66, respectively. RIRS was significantly preferred more than PCNL for stones <1.5cm. Examining the ages, there was no different data described as above for stone sizes. CONCLUSION: Despite RIRS is the new trend for treating stone disease, PCNL remains its important role for especially the larger stone sizes. RIRS is the raising trend for small sizes.

Predictive ability of Guy's stone score in pediatric patients undergoing percutaneous nephrolithotomy.

BACKGROUND: Several authors have evaluated, in a number of external validation and predominantly adult studies, Guy's stone score (GSS) as a predictive tool for the assessment of stone clearance after percutaneous nephrolithotomy (PCNL). However, there are limited and conflicting data investigating whether GSS could be a potential independent factor associated with residual stone rates and complications of PCNL for children. OBJECTIVE: The aim of the current study was to evaluate the ability of GSS, as an independent factor, to predict residual stone rates and complications in pediatric patients undergoing PCNL. STUDY DESIGN: The records of the pediatric patients who had undergone PCNL for stone disease at the current department were retrospectively reviewed. Variables included patient, stone, and treatment parameters. The GSS was used for assessment of stone complexity. Univariate and multivariate analyses were performed to evaluate factors associated with residual stone rates and complications of pediatric PCNL. RESULTS: The study group consisted of 114 children (63 boys and 51 girls) with a median (interquartile range) age of 6 (3-11) years and who had undergone 122 PCNLs (eight bilateral). Multivariate logistic regression analysis (Summary Table) demonstrated that the independent risk factors for increased residual stone rate following pediatric PCNL monotherapy were GSS (OR 3.14, 95% CI 1.31-7.49, P = 0.01) and number of calyces involved (OR 4.02, 95% CI 1.11-14.53, P = 0.033). Multivariate logistic regression analysis demonstrated that the independent risk factors for complications following pediatric PCNL were surgical experience (OR 2.72, 95% CI 1.09-6.82, P = 0.032), and operation time (OR 1.01, 95% CI 1.00-1.03, P = 0.040). DISCUSSION: A prediction model is needed to pre-operatively counsel patients and evaluate outcomes for measuring treatment success of PCNL. The GSS provides a simple, reliable and reproducible tool for describing the complexity of PCNL while predicting postoperative stone-free status, despite its limitations. However, little research has been conducted on the applicability of GSS in pediatric patients undergoing PCNL. In addition, conflicting results have been reported about its association with complications of pediatric PCNL. CONCLUSIONS: The current study found that although GSS had a significant predictive ability for residual stone rates after pediatric PCNL revealed by multivariate logistic regression, the results did not conclude that complexity of GSS was directly proportional to complications of pediatric PCNL. The factors, including calyceal involvement and surgeon experience, may need to be incorporated in GSS to further improve its ability to predict outcomes of pediatric PCNL. IRB APPROVED PROTOCOL NUMBER: 1422.

Predictive value of digital rectal examination for prostate cancer detection is modified by obesity.

The American Cancer Society's updated screening guidelines for prostate cancer (CaP) render digital rectal examination (DRE) optional. We investigated the impact of DRE on CaP detection among obese men. Data from 2794 men undergoing initial prostate biopsy at three centers were analyzed to assess CaP risk attributed to abnormal DRE across body mass index (BMI) categories. Predictive accuracies of a combination of PSA, age, race, center and biopsy year including or excluding DRE findings were compared by areas under the receiver-operating characteristics curves. In all cohorts, obese men were less likely to have abnormal DREs diagnosed than non-obese men. As BMI category increased, abnormal DREs became stronger predictors for overall CaP in individual (P-trends ≤ 0.05) and combined (P-trend<0.001) cohorts, and for high-grade CaP in the Italian (P-trend=0.03) and combined (P-trend=0.03) cohorts. DRE inclusion improved the predictive accuracy for overall and high-grade CaP detection among all obese men (P ≤ 0.032) but not normal-weight men (P ≥ 0.198). DRE inclusion also near-significantly improved overall CaP detection in obese men with PSA<4 ng ml(-1) (P=0.081). In conclusion, the predictive value of DRE is dependent on obesity and is significantly higher among obese men than normal-weight men.

Temporary vascular access via the external iliac vein as a salvage procedure: a report of two cases.

Central venous catheters (CVCs) provide easy, immediate and rapid vascular access (VA) for hemodialysis (HD) in patients with acute renal failure (ARF), and in an increasing number of patients with end-stage renal disease (ESRD) as well. For this purpose, the vessels mainly used are the cephalic, jugular, subclavian and femoral veins. In some patients, vascular catheter insertion via these routes can become impossible. We report two hopeless cases, in which the external iliac veins (EIVs) were used as a temporary VA insertion site as a last resort.