Low-energy high-frequency Ho-YAG lithotripsy: is RIRS going forward? A case-control study.

Retrograde Intra-Renal Surgery (RIRS) plays a primary role in renal stone treatment context. Energy, frequency and width of laser impulse can be modulated by surgeons to achieve better outcomes. In our study, patients with single renal stone sized 10-20 mm were retrospectively divided into two groups. Patients of Group 1 underwent RIRS with Low-Energy (LE) High-Frequency (HF) settings using Lumenis® 120-W high-power Ho:YAG laser. Patients of Group 2 (control) underwent RIRS using "standard" settings by means of Sphinx® Jr 30 W Ho:YAG system. Follow-up was conducted with a CT scan at 3 months after RIRS in both groups. Procedure success was defined as stone-free or presence of ≤ 4 mm fragments (Clinical Insignificant Residual Fragments-CIRF). A total number of 199 patients were included: 86 LE/HF RIRS (Group 1) vs 113 "conventional" RIRS (Group 2). Mean operative time was 56.6 (± 19.4) min in Group 1 vs 65.2 (± 25.2) min in Group 2 (p = 0.01). Mean hospitalization time was 2.5 ± 1.7 days for Group 1 vs 2.9 ± 3.2 days for Group 2 (p = 0.2). Peri-operative complications were counted: eight in Group 1 and 11 in Group 2 (p > 0.05). At 3-month control, stone-free rate was 69% (59/86 patients) in Group 1 vs 65% (73/113 patients) in Group 2 (p = 0.6). Success rate was 93% (80/86) in Group 1 in comparison to 82% (93/113) in Group 2 (p = 0.03). In conclusion, LE/HF RIRS seems to be a feasible and effective technique with a reduction of operative time and optimal results in terms of "stone-free" and "success" rates. Further studies are needed to ensure the validity of our results and to give evidence-based statements.

[Disease progression in bladder cancer: which developments since 1994].

Objectives The introduction of PSA in clinical practice has resulted in decreasing the death rate form prostate cancer and in a downward shift of the pathological stage in radical prostatectomy specimens. This seems not to be the case for bladder cancer. In order to verify this assumption, we have reviewed the charts of the patients operated on of radical prostatectomy and radical cystectomy between 1994 and 2006. METHODS 456 and 491 consecutive patients, respectively, underwent radical cystectomy and radical prostatectomy with bilateral lymph nodes dissection. We excluded all the patients who had received neoadjuvant treatment or did not undergo node dissection. The patients were divided into two consecutive groups according to the year of treatment: group 1 included pts treated from 1994 to 2000, and group 2 pts from 2001 to 2006. The histopathological findings of the two groups of pts were compared. The difference among TNM systems has been balanced evaluating histopathological reports critically and converting them to the 2002 edition. RESULTS. For patients with prostate cancer, those in group 2 had a decrease in the incidence of extracapsular extension and lymph nodes invasion. The bladder cancer patients belonging to group 2 had a greater number of T2, but there was an increased number of pN+ in this group. CONCLUSIONS Even if there is a decline in locally advanced disease in patients with bladder cancer, our retrospective analysis did not show a comparable success in early diagnosis as it did for prostate cancer. There is undoubtedly an increase in the lymph node dissemination, whether this is due to a more extended lymph node dissection or to a premature dissemination remains questionable. Public awareness regarding bladder cancer and its risk factors is limited, but several studies have reported that a delay in diagnosis of invasive bladder cancer is an adverse prognostic factor. A higher care in the development of new diagnostic markers for bladder tumors and especially in the screening protocols together with an earlier radical therapy could hopefully improve the management of such a pathology, as it happened for prostate cancer.