value of a second transurethral resection in evaluating patients with bladder tumors

The role of a routine second transurethral resection in evaluating and managing bladder tumors is defined. From October 1997, 50 patients with new or recurrent bladder tumors underwent repeat transurethral resection within 2 to 6 weeks after the initial resection, and the results, including the presence of residual tumor and tumor stage, were compared. Of the 50 cases 11 [22%] had no and 39 [78%] had residual tumor on repeat transurethral resection. Of 32 cases with superficial [Ta, Tis, T1] bladder tumors 17 [53%] had residual noninvasive tumor and 7 [22%] were up staged to invasive tumor. Among 18 patients with a muscle invasive tumor 3 [17%] had no residual tumor on repeat transurethral resection. Results of the second resection changed tumor treatment in 16 patients [32%]. Many patients with bladder tumors have tumor present after an initial transurethral resection. Routine repeat resection is advised to control noninvasive tumors and to detect residual tumor invasion

significance of stenting after ureteroscopic removal of distal ureteral calculi

We determine the morbidity associated with no stent placement following uncomplicated ureteroscopy for removal of distal ureteral calculi. A total of 93 patients undergoing uncomplicated, complete removal of distal ureteral calculi were contacted 1 to 3 days and 7 to 10 days postoperatively to determine analgesic requirements and time of return to normal activity. Radiological follow-up consisted of an excretory urogram or renal ultrasound 8 weeks postoperatively. Of 93 patients 40 [43%] had no discomfort postoperatively. Of the 53 patients who had discomfort 45 [85%] had mild discomfort only, controlled with oral analgesics. When discomfort occurred it resolved in 41 patients [77%] in 2 days or less. Of 12 patients who required intravenous narcotics postoperatively 5 required preoperative hospitalization for the narcotics and were still hospitalized at the time of stone removal. None of the 59 patients who had follow-up excretory urogram or renal ultrasound has had a newly identified ureteral stricture to date. In the majority of patients undergoing uncomplicated ureteroscopy for removal of distal ureteral calculi postoperative discomfort is modest, lasts less than 2 days and is easily controlled with oral analgesics. Stricture formation has not been identified. We do not believe that routine placement of a ureteral stent following uncomplicated ureteroscopy for distal ureteral calculi is necessary