Does simultaneous inversion during extracorporeal shock wave lithotripsy improve stone clearance: a long-term, prospective, single-blind, randomized controlled study.

OBJECTIVE: To determine the efficacy of a combination of simultaneous shock wave lithotripsy (SWL), hydration with controlled inversion therapy compared with SWL with hydration alone in patients with lower pole calyx stones. METHODS: Patients with lower pole stones (4-20 mm) were randomized to SWL or SWL with simultaneous inversion therapy (30° head down Trendelenburg position). Standardized shock waves were given to all patients stratified according to stone size. Subsequent standardized shock waves were given to patients with stone fragments determined by plain abdominal radiography and ultrasound by 2 radiologists blinded to treatment at day 1, weeks 2, 4, 12, 24, and at 1 year. The primary endpoint is stone-free rate (SFR) at week 12. RESULTS: A total of 140 patients were recruited into the study. Patients were comparable with respect to age, sex, race, and stone parameters at baseline. The overall SFR at week 12 was 72% (n = 49 of 68) in patients with SWL and 76% (n = 54 of 71) in SWL with simultaneous inversion at the end of study (P = .591). There was a trend for SFR to improve over time with >80% of patients being stone-free after 1 year in both groups. No significant adverse effects were noted in both groups of patients. CONCLUSION: Although not statistically significant, SWL with simultaneous inversion is a valuable adjunct in assisting the passage of lower pole renal stones with a SFR of 76%. In clinical practice, this also translates to a 1.28 times improvement in SFR with no or minimal additional costs.

A better way to manage perinephric abscesses: percutaneous ultrasonography-guided endoscopic lavage.

PURPOSE: To report the efficacy and safety of percutaneous ultrasonography-guided endoscopic lavage in the management of perinephric abscesses. PATIENTS AND METHODS: This is a retrospective review of patients in a single center who had perinephric abscesses and were treated by percutaneous ultrasonography-guided endoscopic lavage during the period of March 2001 to March 2013. Information including the demographics, comorbid medical conditions, presenting symptoms, size of abscesses, operation information, and postoperative information were retrieved for review. RESULTS: There were 37 patients (40 operations) identified during the study period. The mean age was 56.8 years (21-91 years). Eighteen (48.9%) patients presented with loin pain (48.6%) and/or fever (18, 48.6%), and the mean diameter of the abscesses was 10.8 cm (5-22 cm). Thirty-one (77.5%) procedures were performed under general anesthesia. The mean operative time was 49.4 minutes (15-140 min). Thirty-one (77.5%) patients had their percutaneous track dilated to 32F. Only two of 37 (5.4%) patients needed repeated drainage. The average postoperative drainage time was 8.35 days (3-21 days). The median postoperative hospital stay for our patients was 10 days (4-101 days). There was no mortality related to the abscess in this cohort. CONCLUSION: Percutaneous Ultrasonography-guided endoscopic lavage was shown to be an effective and safe approach for patients with perinephric abscesses.

Breast ductal carcinoma in situ presenting as recurrent non-puerperal mastitis: case report and literature review.

Breast ductal carcinoma in situ (DCIS) is a preinvasive form of breast cancer. It typically presents as microcalcifications which are picked up on screening mammogram. We report an atypical case of breast DCIS presenting with recurrent non-puerperal mastitis with a normal mammogram and perform a literature review.

Chronic prostatitis/chronic pelvic pain syndrome: role of alpha blocker therapy.

INTRODUCTION: This article reviews the rationale and data supporting alpha blocker therapy for chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS), the most common and difficult prostatitis syndrome. METHODS: Systematic review identified ten clinical trials evaluating alpha blocker therapy for patients with CP/CPPS, including five open-label or small prospective studies and five double-blinded and placebo-controlled clinical trials. RESULTS: Encouraging results in uncontrolled and small clinical trials led to the development of reasonably powered, double-blinded, placebo-controlled, randomized clinical trials evaluating terazosin, doxazosin, tamsulosin, and alfuzosin. CONCLUSIONS: Current data suggest that treatment-naïve and/or newly diagnosed patients appear more likely to respond than long-term, chronic refractory patients. Longer courses of treatment (12 weeks to 6 months) appear superior to shorter courses, and less selective agents appear superior to more selective alpha1 blockers. These observations outline important questions that must be answered to define optimal treatment strategies for patients with CP/CPPS.