External validation of Modified Seoul National University Renal Stone Complexity Score to predict outcome and complications of retrograde intrarenal surgery: a RIRSearch Group study.

INTRODUCTION: The Modified Seoul National University Renal Stone Complexity Score (S-ReSC) is a simple model based solely on stone location regardless of stone burden. The aims of this study were to validate S-ReSC for outcomes and complications of retrograde intrarenal surgery (RIRS) and to evaluate its predictive power against the stone burden. MATERIAL AND METHODS: Data of 1007 patients with kidney stones who had undergone RIRS were collected from our RIRSearch database. Linear-by-linear association, logistic regression, ANOVA/post hoc analysis and ROC curve (with Hanley and McNeil's test) were used for evaluation. The main outcomes were stone-free status and complications of RIRS. RESULTS: The overall stone-free rate was 76.8% (773/1007). Higher S-ReSC scores were related to lower stone-free rates and higher total, perioperative and postoperative complication rates (p<.001, p<.001, p=.008 and p<.001, respectively). S-ReSC score (p=.02) and stone burden (p<.001) were independent predictors of stone-free status. But stone burden (AUC = 0.718) had a more powerful discriminating ability than the S-ReSC score (AUC = 0.618). CONCLUSIONS: The S-ReSC score is able to predict not only stone-free status but also complications of RIRS. Although this location-only based scoring system has a fair discriminative ability, stone burden is a more powerful predictor of stone-free status after RIRS. An ideal scoring system aiming to predict outcomes of RIRS must include stone burden as a parameter.

Comparison of a Modified Antegrade and Retrograde Ureteral Double-J Stenting Techniques during Laparoscopic and Robotic Pyeloplasty.

INTRODUCTION: To compare the effect of a modified antegrade and retrograde double-J stenting techniques on stenting and operation time in patients who underwent laparoscopic or robotic pyeloplasty. METHODS: A total of 74 patients undergoing transperitoneal laparoscopic or robotic pyeloplasty were enrolled into this study. The antegrade (Group 1) and retrograde (Group 2) techniques were compared for operation time, stenting time, complication, and reoperation rates. RESULTS: There were 41 and 33 patients in Groups 1 and 2, respectively. Both groups were similar in terms of age, side, and gender distribution. The mean operation times were 122.4 and 139.7 min in Groups 1 and 2, respectively (p < 0.001). The stenting times were 2.39 and 14.15 min in Groups 1 and 2, respectively (p < 0.001). The reoperation and complication rates were 7.3 and 6%, respectively, and similar for both groups (p = 1). CONCLUSIONS: Our new technique significantly shortens the duration of laparoscopic and robotic pyeloplasty without compromising success and complication rates.

Epithelioid malignant peripheral nerve sheath tumor of the bladder and concomitant urothelial carcinoma: A case report.

BACKGROUND: Epithelioid malignant peripheral nerve sheath tumor (EMPNST) of the bladder is a rare entity with devastating features. These tumors are thought to originate from malignant transformation of pre-existing schwannomas of pelvic autonomic nerve plexuses, and unlike the conventional malignant peripheral nerve sheath tumor (MPNST), are not associated with neurofibromatosis. The tumor has distinctive morphological, immunohistochemical and molecular features. Additionally, it tends to be more aggressive and have a higher mortality. This is the first case that presents with a synchronous urothelial carcinoma of the bladder and the epithelioid variant of MPNST in the literature. It's also the second reported case of EMPNST originating from the bladder wall. CASE SUMMARY: In this case report, we present the detailed clinical course of a 71-year-old patient with EMPNST of the bladder alongside a literature review. CONCLUSION: During the management of EMPNST cases, offering aggressive treatment modalities to the patient, such as radical cystectomy, is appropriate for the best chance to contain the disease, regardless of the tumor stage and the extent of local disease at initial diagnosis.

Comparison of Laparoscopic and Open Ureterolysis for Retroperitoneal Fibrosis: Results from a Tertiary Referral Center.

Objectives: To compare the surgical outcomes of open and laparoscopic ureterolysis procedures in patients requiring surgical treatment for ureteral obstruction caused by retroperitoneal fibrosis (RPF). Materials: This study was designed retrospectively. The clinical records of patients who underwent ureterolysis between January 2005 and April 2019 because of ureteral obstruction caused by RPF were examined. According to the type of surgery, the patients were divided into two groups as Group 1 (open ureterolysis) and Group 2 (laparoscopic ureterolysis). Demographic features, preoperative-postoperative renal functions, duration of follow-up with ureteral stents, and perioperative-postoperative complications were examined. The requirement of ureteral stent placement during the follow-up period was accepted as unsuccessful ureterolysis. Results: Ureterolysis was performed in 13 patients and 23 renal units. Eleven of these patients were men and two were women. The median age of the patients was 54 (44-68) years. There were six patients and 12 renal units in Group 1 and seven patients and 11 renal units in Group 2. Postoperatively, a total of four patients (30%) had minor complications (Clavien-Dindo 1-2) and one patient had a major complication (Clavien-Dindo 3a). Ureterolysis was determined to be effective in 21 of the renal units (91%) [11/12 (92%) in Group 1 vs 10/11 (91%) in Group 2]. No statistically significant difference was found between the groups in terms of the success and complication rates (p = 1 and p = 0.529, respectively). Postoperative hospitalization length and recovery time to return to normal preoperative activities were significantly shorter in Group 2 than in Group 1 (p = 0.011 and p = 0.041, respectively). Conclusions: The success and complication rates were similar between the open and laparoscopic methods for ureterolysis. Laparoscopic approach was advantageous over open approach in terms of postoperative hospitalization length and recovery time to return to normal preoperative activities.

Mixed Epithelial and Stromal Tumor Family of Kidney (Adult Cystic Nephroma, Mixed Epithelial and Stromal Tumor): Retrospective Clinicopathological Evaluation.

OBJECTIVE: Tumors belonging to the mixed epithelial stromal tumor family (MESTF) are rare; thus clinicopathological experience about them are limited. Each epithelial and stromal component shows different patterns in these tumors. MATERIAL AND METHOD: Clinicopathological features of 11 MESTF cases that were diagnosed between 2000 and 2021 at a single center were evaluated. RESULTS: Ten of the 11 patients were female (F:M = 10:1). The mean age of the females was 47 (31-63) years; the male patient was 45 years old. The mean tumor diameter was 6.7 (3.5-19) cm. All tumors had varying proportions of cystic and solid components. Eight cases were well circumscribed, and the others had distinct but irregular borders. Two of the tumors with irregular borders were bulging into the renal sinus. The epithelial component was dominant in most cases. In the epithelial component, macrocyst, microcyst, and tubules were the most common patterns and the most common types of lining epithelium were flat, cuboidal and hobnail. The stromal component was variable in most cases and included hypocellular (mostly collagenous) and cellular areas. In most cases, the cellular stroma had an ovarian-like appearance. Among the other features observed, hyalinization and dystrophic calcification were common. The positivity for estrogen and progesterone receptor in the stromal component was observed in almost all female cases. CONCLUSION: MESTF, which has distinctive features, should be considered in the differential diagnosis of cystic kidney tumors.