Multicenter experience with metallic ureteral stents for malignant and chronic benign ureteral obstruction.

BACKGROUND AND PURPOSE: A new coil-based metallic ureteral stent offers greater radial strength with longer indwelling time compared with plastic stents. This multicenter retrospective study reviews the clinical experience with this stent for malignant or benign chronic ureteral obstruction. PATIENTS AND METHODS: Patients had stent placement in a retrograde fashion. We analyzed preplacement and postplacement renal imaging to determine degree of hydronephrosis. Stent encrustation was determined by either visual inspection at the time of stent change or plain abdominal radiography. Preoperative and follow-up serum creatinine values were compared for each patient. RESULTS: A total of 76 stents in 59 renal units (40 patients) were successfully placed. Creatinine value follow-up on 54 renal units showed 20 (37%) units to have stable, 15 (28%) improved, and 19 (35%) with worsening values. No stent showed encrustation on plain radiography despite it being seen on two during direct visualization. Three stents needed operative removal with either percutaneous nephrolithotomy or cystolitholapaxy. Fifteen of 41 (37%) metallic stents placed because of an obstructed plastic stent also became obstructed. At last follow-up, 6 of 40 patients were kept from nephrostomy tubes because of the metallic stent. CONCLUSIONS: Metallic stents are a viable alternative to nephrostomy tubes in patients in whom conventional stents fail because of malignant obstruction, but patients need to be followed closely. Stent encrustation that resulted in retained stents was poorly visualized on plain radiography. Patients still remain at risk for obstruction, urinary tract infections, and lower urinary tract symptoms from the metallic stent.

Percutaneous renal surgery: use of flexible nephroscopy and treatment of infundibular stenoses.

Abstract Percutaneous nephrolithotomy is now the gold standard for treatment of large renal stones. In this article, we describe the indications for use of antegrade flexible nephroscopy during percutaneous nephrolithotomy, as well as for treatment of infundibular stenosis. We also discuss various new technologies to help in these endeavors, including digital cystoscopes and ureteroscopes and our preferred baskets, as well as our particular techniques for improving stone-free rates. The treatment of infundibular stenosis through percutaneous access is also reviewed.

Prostate cancer screening and disease management: how screening may have an unintended effect on survival and mortality-the camel's nose effect.

PURPOSE: Evidence suggests that men diagnosed with prostate cancer live as long as or longer than those without a diagnosis. We postulate that a reason for this paradox is increased preventive and therapeutic health care interventions following a prostate cancer diagnosis. We explored this phenomenon in patients surgically treated for prostate cancer. MATERIALS AND METHODS: We examined the records of patients who underwent radical prostatectomy at Audie L. Murphy Veterans Hospital between 2001 and 2004, focusing on cancer related and comorbidity data including new diagnoses, interventions and medications. RESULTS: A total of 174 subjects had complete data for review. Of these men 72% had a change in medical regimen after diagnosis, 61% had a change in medication and 29% received a new medical diagnosis. Three men underwent cardiac catheterization and 1 had coronary bypass surgery. CONCLUSIONS: These data highlight the extent of evaluation and subsequent changes in medical treatment regimens that occur after a diagnosis of prostate cancer. Such interventions would be expected to affect survival outcomes of men recently diagnosed with prostate cancer.