Non-invasive Detection of Bladder Cancer by UBC Rapid Test, Ultrasonography and Cytology.

BACKGROUND/AIM: There is a need to diagnose early bladder cancer by non-invasive tests. This study aimed to explore the clinical value of three non-invasive methods, UBC Rapid, ultrasound (US), and urine cytology, separately and in combination, for the primary diagnosis and surveillance of bladder-cancer. PATIENTS AND METHODS: Urine samples were obtained from 106 patients who presented with symptoms of bladder cancer and patients followed-up after transurethral resection of bladder tumors (TURB). Each patient underwent US, cystoscopy, cytology and UBC Rapid test. The sensitivity and specificity of all methods and combinations were calculated and related to cystoscopy and biopsy. RESULTS: Voided urine samples assayed with UBC Rapid and cytology yielded a sensitivity and specificity of 58.3% and 75.9%, and 57.1% and 98.0%, respectively and for US 76.2% and 98.1%. The combination of all three methods resulted in a sensitivity and specificity of 95.8% and 67.3%, and the combination of UBC Rapid and US, gave a sensitivity of 91.3%, and a specificity of 72.2%, The combination of UBC Rapid and cytology yielded a sensitivity and specificity of 84.6% and 71.2%. CONCLUSION: Combined use of UBC Rapid, US and cytology improved the sensitivity of bladder cancer detection.

Factors Predicting Operating Room Time in Ureteroscopy and Ureterorenoscopy.

BACKGROUNDS/AIMS: Operation room (OR) time is of great value affecting surgical outcome, complications and the daily surgical program with financial implications. METHODS: We retrospectively evaluated 570 consecutive patients submitted to ureteroscopy or ureterorenoscopy for the treatment of ureteral or renal stones. Demographic parameters, patient's stones characteristics, type of ureteroscope, surgeon experience and surgical theater characteristics were analyzed. OR time was calculated from the initiation of anesthesia to patient extubation. Multivariate analysis was conducted using a linear regression test with multiple parameters to identify predictors of OR time. RESULTS: Eight factors were identified as significant. These include total stones volume, ureteroscope used, stone number, nurses experience, radio-opacity of the stone on kidney-ureter-bladder X-ray, main surgeon experience, operating room type, and having a nephrostomy tube prior to surgery. CONCLUSIONS: The surgical team experience and familiarity with endourological procedure, and the surgical room characteristics has a crucial impact on OR time and effectiveness.

A study of prostate volumes in patients with spinal cord injury.

AIMS: To evaluate the development of benign prostatic hyperplasia (BPH) in patients with spinal cord injury (SCI) and to deduce the role of the nervous system in this process. METHODS: Prostate volumes (PVs) of 65 men older than 30 years of age who sustained SCI were determined from CT scans. Correlations of PVs with SCI level, age, age during SCI and duration of paralysis were calculated. RESULTS: Average patient's age during SCI was 37.7 (±19) years and during measurement of PV 54.8 (±15.3) years. PVs of patients with SCI were similar to expected age-adjusted volumes (29.7 ± 24 mL vs 29.9 ± 5.7 mL, P = 0.95). We dichotomized the cohort into two groups: High SCI (T5 and above) and low SCI (T6 and below) with almost identical: number of patients, age of SCI and duration of paralysis. Patients with lower injuries, had significantly smaller PVs when compared both to patients with higher injuries (19.4 ± 6.3 and 39.8 ± 30, P = 0.0006) and to age-adjusted normal PVs (19.4 ± 6.3 and 29.2 ± 5.8, P = 0.0005). Correlation of PV with age was found in patients higher injuries (R2 = 0.26, p = 0.003) but not in patients with lower (R2 = 0.08, P = 0.11). Moreover, patients with lower SCI had significantly smaller prostate even compared to expected PVs during SCI (18.7 ± 4.6 cc vs 27.8 ± 6.9 cc, P = 0.00006). CONCLUSIONS: Low SCI stops and reverses age related increase in PV. This phenomenon does not occur in high SCIs. This suggests that continuous support of the nervous system is essential for sustaining BPH and raises the possibility of finding a non-hormonal pharmacological intervention for reversing BPH.

[ACTIVE SURVEILLANCE IN RECURRENT LOW-RISK BLADDER TUMORS].

OBJECTIVES: To report our experience with the active surveillance policy in patients with recurrent low-risk bladder tumors. METHODS: The files of 52 patients who underwent active surveillance instead of immediate surgical resection were reviewed. Different variables concerning tumor growth rate were evaluated. RESULTS: A total of 75 surveillance periods were documented in 52 patients (mean age 75.6 years S.D. 10.45 years, 37 males and 14 females), Mean surveillance period length was 16.5 months (S.D. 16.1). All tumors resected after surveillance were found in stage Ta and in low-grade except one tumor which was high-grade; 70 active surveillance periods ended with tumor resection, and 5 patients were still under surveillance when the research ended; 27 surveillance periods (37.7%) ended because of the growth of additional tumors. Active surveillance therefore spared 27 surgeries. The rate of tumor growth during surveillance depended on the tumor's largest diameter at the beginning of surveillance. If initial tumor diameter was smaller than 5 mm (68 cases), the median tumor growth rate was 1.12 mm3/month (IRQ: 0-6.55). If the initial tumor diameter was ≥5 mm (7 cases), the median tumor growth rate was 137.14 mm3/month (IRQ: 2.21-1787.5, p < 0.05). CONCLUSIONS: Small, recurrent papillary bladder tumors pose minimal risk to the patient. An active surveillance policy, without immediate resection of the tumor is safe, can spare surgeries and can be considered in patients presenting with small papillary recurrence.

Abbreviated CT protocol for postoperative surveillance of renal cancer.

INTRODUCTION: Postoperative surveillance protocols after nephrectomy for kidney cancer include periodic computed tomography (CT) scans of the chest and abdomen. A single study exposes the patient to 21 mSv (equivalent to 7-year exposure to natural background radiation). The objective of this study was to evaluate the hypothesis that an abbreviated CT protocol restricted to the chest and upper abdomen (i.e., to the level of the intervertebral disk L3-L4) is sufficient for routine postnephrectomy follow-up as it detects most tumor recurrence with lower radiation exposure. METHODS: We identified 493 patients treated with radical or partial nephrectomy for localized kidney cancer and followed with periodic CT scans of the chest and abdomen for prolonged periods. The frequency and location of cancer recurrence were documented. The ratio of infield recurrence for the complete chest, and abdomen and for the abbreviated protocol was recorded. The decrease in radiation exposure was calculated. RESULTS: At a median follow up of 96 months, 82 patients (16.6%) developed recurrence. The frequent sites of recurrence were the lungs (53), the bones (9), and local recurrence (22). Complete chest and abdominal CT identified 78 of the recurrences (95%) and the abbreviated protocol identifying all but one of these (94%). The abbreviated protocol exposed the patient to 48% (standard deviation 4.3%) less radiation compared to the full protocol. CONCLUSIONS: Using an abbreviated CT protocol that includes the chest and upper abdomen for surveillance after surgery of localized kidney cancer decreases radiation exposure by half with only a minor decrease in the sensitivity of the examination.

"Stoneless" or Negative Ureteroscopy: A Reality in the Endourologic Routine or Avoidable Source of Frustration? Estimating the Risk Factors for a Negative Ureteroscopy.

INTRODUCTION: A "Negative" ureteroscopy (URS) is defined as a URS in which no stone is found during the procedure. It may occur when the stone has already been passed spontaneously or when it is located outside the collecting system. The aim of the study was to outline risk factors for Negative-URS. MATERIALS AND METHODS: We retrospectively analyzed the possible risk factors for Negative-URS from a database of 341 URS cases. In every case where presumptive ureteral stone was not found, a formal nephroscopy as well as a whole collecting system revision was completed. The Negative-URS group was compared with the non-Negative-URS group, in terms of patient and stone characteristics. RESULTS: The database of 341 URS cases included 448 different stone instances, of which 17 (3.8%) were negative and 431 (96.2%) were therapeutic. There was no statistical significant difference between the two groups concerning age, body mass index, stone location in the ureter, stone laterality, and whether the patient was prestented. The stepwise multiple logistic regression revealed three important risk factors, namely CT stone surface area (p < 0.0001), radiopacity of the stone at kidney, ureter, and bladder radiograph (KUB; p = 0.0004), and gender (p = 0.0011) with an area under the curve of 0.91. Women were found to have more possibilities to have a negative procedure by four- to sevenfold than men depending on the model. A nonradio-opaque stone at KUB is more likely to be correlated with a Negative-URS by 9.5- to 11-fold more than a radiopaque stone at KUB. For each increase of 1 U in CT stone surface area, there is an increase of 10%-12% to be non-negative. CONCLUSIONS: Female gender, a nonradio-opaque stone at KUB, and a smaller stone surface were statistically significantly different in the Negative-URS population.

High frequency of bladder cancer after nephroureterectomy: justification for adjuvant intravesical treatment?

BACKGROUND: Bladder recurrence after nephroureterectomy (NU) is common. However, there is no acceptable policy of adjuvant intravesical treatment after NU. OBJECTIVE: To assess the rate of bladder recurrence following NU and to identify the high-risk subgroups that may become candidates for adjuvant intravesical therapy after NU. PATIENTS AND METHODS: Ninety-one patients (mean age 66.4 years) underwent NU. High-grade (HG) tumors were found in 63 patients and low-grade (LG) tumors in 28. Median follow-up was 72 months. The risk of bladder recurrence was assessed by uni- and multivariate analyses of patient and tumor characteristics. RESULTS: Bladder recurrence developed in 38 patients (41.8%) after a median period of 11 months. Among these, 25 patients with HG upper tract urothelial carcinoma (39.7%) and 13 patients with LG upper tract urothelial carcinoma (46.4%) developed recurrence. HG bladder recurrence developed in 24 patients (63.2%) and LG recurrence developed in 14 patients (36.8%). Stages pTa, pT1, pT2, or higher bladder recurrence developed in 26 (68.4%), 7 (18.4%), and 4 patients (10.5%), respectively, and pure pTis developed in 1 patient. On uni- and multivariate analyses, the risk of bladder recurrence was independent of any clinicopathologic characteristics. CONCLUSION: High rate and short time interval of bladder recurrence after NU were found, with no specific subgroup of patients with increased risk. These findings support prescribing adjuvant intravesical therapy to all patients after NU.

Does Retrograde Treatment of Upper Urinary Tract Stones Necessitate Postoperative Upper Urinary Tract Drainage? Conclusions from More Than 500 Single Center Consecutive Cases.

BACKGROUND AND PURPOSE: Temporary drainage of the upper urinary tract after ureterorenoscopy for the treatment of urinary stones is almost a routine in endourologic practice. In these cases, a Double-J stent (DJS) is left for 7 or more days. In borderline cases, a ureteral catheter attached to the urethral catheter may be left for 24-48 hours. In some situations, tubeless approach is possible. The purpose of this study was to evaluate the necessity and immediate postoperative implications of upper tract drainage by comparing complications and symptoms at the immediate postoperative period in these three groups of patients. MATERIALS AND METHODS: A database of 516 consecutive patients who underwent ureterorenoscopy for ureteral and/or renal stones between October 2014 and September 2016 was retrospectively evaluated. The cohort was divided according to postoperative drainage type of the upper urinary tract. The data consisted of demographic parameters, stone location, number and burden, severity of preoperative obstruction, and postoperative complications. Symptoms at the immediate postoperative period, assessed by visual analog scale (VAS) score, frequency, and type of analgesics used, were evaluated and compared. Categorical dependent variables were evaluated using chi-square or Spearman's correlation tests, whereas continuous dependent variables were analyzed using Pearson correlation analysis. RESULTS: There were 196 (38%) tubeless, 214 (41%) UC, and 106 (21%) DJS cases. Patients who were drained with DJS at the end of the procedure were significantly with higher stone volume (p < 0.005), higher stone density (p < 0.005), and with more severe preoperative obstruction (p < 0.005). Postoperative complications (infection, stone-street, and acute renal failure), mean VAS score, or analgesics used were not different in the three subgroups. CONCLUSIONS: A tubeless approach is safe in properly selected cases. There is no difference in postoperative course compared with drained groups. Tubeless procedures may facilitate an outpatient approach for treatment of upper urinary tract stones.

[PERCUTANEOUS TREATMENT OF SMALL RENAL TUMORS BY THERMAL ABLATION].

INTRODUCTION: Kidney cancer accounts for approximately 2-3 % of all types of cancers. Renal tumors prevalence and especially the prevalence of small renal tumors, is on the rise. About half of the tumors currently diagnosed are smaller than 4 cm. Minimally invasive methods of radiofrequency ablation technology were recently developed for the treatment of small renal tumors and are characterized by reducing the surgical and anesthetic risk. The ablation is performed with a percutaneous approach guided by ultrasound, CT or MRI. We reviewed the results of this treatment. METHODS: A total of 75 patients with a mean age of 69.5 years (27 - 90) were treated using RF during the period 2007-2014. The average tumor diameter was 28.4 mm (11-58 mm); 40 tumors were exophytic and 30 were central. Monitoring protocol after treatment included imaging after 1, 3, 6, 12 months subsequent to treatment and later annually; median follow-up time was 21 months (1 - 97). RESULTS: Evidence of tumor recurrence was observed in 9 patients (11.4%); 8 were treated successfully by another RF session. Cases in which recurrence was observed were characterized by a tumor larger than 30 mm (5/9) and adjacent to renal cysts (3/9); 5 of the lesions were central (endophytic) (P=0.5). One patient died due to metastatic RCC and a metastatic disease developed in two additional patients who died of other causes. CONCLUSIONS: It is possible to destroy most of the small renal tumors by RF ablation. When the tumor size is up to 30 mm, a 94% long-term cure may be reached. In the event of renewed growth of the tumor, the treatment can be repeated with good results. In light of short-term experience, it is recommended to limit this treatment to older patients, with a short life expectancy or when anesthetic risks prohibit surgery.

'Very-low-risk' bladder tumours - a new entity?

OBJECTIVE: To evaluate the homogeneity of the 'low-risk' bladder cancer group in an attempt to optimise follow-up protocols. PATIENTS AND METHODS: Between June 1998 and December 2008, 211 patients (mean [sd] age of 66.7 [12.8] years) underwent transurethral resection of low-risk bladder cancer. Postoperative follow-up included cystoscopy at 3 and 12 months after surgery, then annually for a total of 5 years, and then annual ultrasonography indefinitely. RESULTS: After a median follow-up of 10 years, 65 patients (30.7%) developed tumour recurrence and three (1.4%) stage progressions. In all, 84 patients (40%) had tumours of ≤1 cm; these patients were significantly younger than patients with 1.1-3 cm tumours (64.6 vs 68.3 years, P = 0.03). Their 5-year recurrence-free survival rate was significantly higher (92% vs 70% in patients with larger tumours, P < 0.001). The median time to recurrence was 5.7 years in patients with smaller tumours and 3.6 years in patients with larger tumours (P = 0.03). Only 43.7% of the recurrences in patients with small tumours occurred within 5 years, compared to 75.5% in patients with larger tumours. CONCLUSIONS: Patients with low-risk bladder cancer make an inhomogeneous group. They can be stratified according to tumour size. Patients with tumours of ≤1 cm are younger, have lower risk of tumour recurrence, and most of their recurrences arise beyond the recommended 5-year surveillance period. It seems that these patients can be classified separately to a 'very-low-risk' group. Follow-up in these cases can be based on prolonged non-invasive evaluations.

The Transparency of Irrigation Fluids Used in Endoscopic Surgery.

PURPOSE: Transurethral surgery has been traditionally done using the nonelectrolyte, isotonic 1.5% glycine solution as irrigation fluid. The emergence of modern technologies, which can be applied with electrolyte solutions, such as bipolar resection and LASER evaporation, as well as the worry of transurethral resection (TUR) syndrome have driven urologists away from glycine toward the use of physiologic solution. Differences in the transparencies of these fluids have not been studied. MATERIALS AND METHODS: The ability to resolve two bars at 1 mm apart using a 30° cystoscope lens immersed in different solutions was studied. Physiologic solution, distilled water (DW), and 1.5% glycine solutions containing increasing concentrations of blood, from 0.5% to 2%, were tested. Solutions containing 2% blood were inspected with magnification and microscopy. RESULTS: One-millimeter resolution was reached in as much as 2% blood in 1.5% glycine solution and as much as 1% blood in DW, but in none of the blood-saline solutions. Magnified and microscopic views of 2% blood solutions showed an even distribution of red blood cells (RBCs) in physiologic solution, clumps of RBCs in 1.5% glycine, and an almost complete hemolysis in DW. CONCLUSIONS: Glycine solution increases the transparency compared to physiologic solution or DW owing to the clumping of RBCs. When the risk of TUR syndrome is low, as in resection of bladder tumors or small prostates, we propose that 1.5% glycine solution should be preferred over saline, owing to its improved visibility.

Retrograde versus Antegrade Approach for the Management of Large Proximal Ureteral Stones.

Objective. To evaluate and compare the efficacy and safety of retrograde versus antegrade ureteroscopic lithotripsy for the treatment of large proximal ureteral stones. Patients and Methods. We retrospectively analyzed the medical records of patients with proximal ureteral stones >15 mm, treated in our institution from January 2011 to January 2016. Intraoperative parameters, postoperative outcomes, and complications were recorded and compared between the two techniques. Results. Our analysis included 57 patients. Thirty-four patients (59.6%) underwent retrograde and 23 patients (40.4%) underwent antegrade ureteroscopy. There was no significant difference in patients' demographics and stone characteristics between the groups. Stone-free rate was significantly higher (p = 0.033) in the antegrade group (100%) compared to retrograde one (82.4%). Fluoroscopy time, procedure duration, and length of hospitalization were significantly (p < 0.001) lower in retrograde approach. On the other hand, the need for postoperative stenting was significantly lower in the antegrade group (p < 0.001). No difference was found between the groups (p = 0.745) regarding postoperative complications. Conclusions. Antegrade ureteroscopy is an efficient and safe option for the management of large proximal ureteral stones. It may achieve high stone-free rates compared to retrograde ureteroscopy with the drawback of longer operative time, fluoroscopy time, and length of hospitalization.

Interobserver Reliability and Reproducibility of the Clinical Research Office of the Endourological Society Nomogram in Predicting Percutaneous Nephrolithotomy Results.

OBJECTIVE: To assess interobserver reliability and reproducibility of the Clinical Research Office of the Endourological Society (CROES) nephrolithometric nomogram. PATIENTS AND METHODS: Preoperative data and postoperative outcomes of 100 consecutive patients who underwent percutaneous nephrolithotomy were obtained. Patients' data were reviewed separately by 4 independent urologists of different academic level: an experienced attending endourologist, a graduated fellow, a young fellow, and a resident. Each rater adjusted a CROES score in all 100 patients. Interobserver reliability was analyzed by assessing intraclass correlation (ICC) and kappa coefficient among and between all different raters. RESULTS: Assessment of interobserver reliability showed good or excellent agreement among all raters. Moderate agreement was only found between the raters for the "presence of staghorn" score. ICCs among all raters expressed excellent levels for each independent CROES parameter and reached great statistical significance. The highest correlation was noticed for "stone burden" in contrast to "presence of staghorn" parameter that showed the lowest. ICC for the final CROES score revealed good to excellent agreement among all raters and all pairs of raters. CONCLUSION: CROES nephrolithometry is a reproducible nomogram. Reproducible results were obtained within a single institution by multiple reviewers of varying experience within a short period of time after undergoing standardized training.

External validation of Resorlu-Unsal stone score as predictor of outcomes after retrograde intrarenal surgery.

PURPOSE: To externally validate Resorlu-Unsal stone score (RUSS) and to evaluate its predictive accuracy. METHODS: Data of patients who underwent retrograde intrarenal surgery (RIRS) between October 2013 and June 2015 were collected. RUSS was applied to all patients, and the nomogram was externally validated. Area under the curve (AUC) was used for clinical validity assessment. RESULTS: A total of 85 patients were included in the study. Mean patient age was 54.3 ± 16.5, and mean stone size was 12.0 ± 6.21 mm. After applying RUSS, 56.5, 28.2, 9.41, and 5.88 % had score 0, 1, 2, and 3, respectively. RUSS was significantly associated with stone location and size. Postoperative stone-free rate was 74.1 %. Postoperative outcomes were significantly associated with RUSS and stone size. RUSS was found to be the only significant independent predictor in multivariate analysis, while it provided high predictive accuracy with an estimated AUC of 0.707. CONCLUSIONS: RUSS is a simple scoring system that may predict postoperative stone-free rate after RIRS with great efficacy and accuracy.

Serum Thymidine Kinase 1 Activity Following Nephrectomy for Renal Cell Carcinoma and Radiofrequency Ablation of Metastases to Lung and Liver.

BACKGROUND/AIM: Thymidine kinase 1 (TK1) is involved in DNA synthesis and is considered a reliable and sensitive marker of cell proliferation. The aim of this study was to investigate the prognostic value of measurements of serum TK1 activity following tumor ablation. PATIENTS AND METHODS: This study was performed on 32 patients with renal cell carcinoma (RCC) who had undergone nephrectomy and 35 patients with cancer of different histology with metastases to the liver (n=28) and lung (n=7) treated with radiofrequency ablation (RFA). The TK1 activity was measured with DiviTum (Biovica) immunoassay. RESULTS: In patients with RCC with no evidence of disease during their observation, a significant decrease of the TK1 activity was observed on the day following nephrectomy (p<0.0001). The mean calculated half-life ±SEM was 10.8±1.2 h. Taking into account the short half-life, measurements of TK1 were performed 24 h after nephrectomy or RFA of metastases. It was found that elevated TK1 activity (>60 Du/l) on the day after nephrectomy independently predicted poor recurrence-free survival (hazard ratio=5.0, p=0.040), after adjustment for T-stage, age and pretreatment TK1. Patients scheduled for RFA averaged 1.4 lesions and an average lesion diameter of 2.2 cm. Multivariate Cox's regression model demonstrated the significant association of any increase of TK1 activity or decrease not reaching ≤60 Du/l on the day after ablation with poor progression-free survival (hazard ratio=4.6, p=0.001), after adjustment for the type of primary tumor, the number and size of metastases. CONCLUSION: The half-life for serum TK1 activity is 10.8±1.2 h. The measurements of TK1 activity following nephrectomy or RFA of metastases could be an important tool in prognostic evaluation.

Pregnancy Rates after Testicular Torsion.

PURPOSE: To our knowledge the effect of testicular torsion on the pregnancy rate is unknown. In this study we focused on the pregnancy rate, which is the ultimate index of fertility status. MATERIALS AND METHODS: We reviewed the records of 273 patients who presented to our emergency room with testicular torsion between 1994 and 2014. Study inclusion criteria included being in a relationship with the intent to conceive for at least 1 year, age greater than 25 years and a normal contralateral testis. Patients with primary infertility, those who were unwilling to participate or unreachable and those with a history of undescended testis and/or varicocele were excluded from analysis. Patients were contacted by telephone and interviewed according to a standardized questionnaire. Pregnancy rates in the orchiopexy and orchiectomy groups were compared to each other and to the accepted pregnancy rate in the literature. RESULTS: A total of 63 patients met study inclusion criteria, including 41 and 22 in the orchiopexy and orchiectomy groups, respectively. The pregnancy rate in the orchiopexy and orchiectomy groups was 90.2% and 90.9%, respectively (p = 1.0). The accepted pregnancy rate in the general population is 82% to 92%. Mean ± SD time to pregnancy in the orchiopexy and orchiectomy groups was 6.6 ± 5.50 and 7.2 ± 5.4 months, respectively (p = 0.27). CONCLUSIONS: Several studies suggest decreased fertility potential in patients with a history of testicular torsion. However, in the current study in couples in which the male had a history of testicular torsion the pregnancy rate and the interval to pregnancy were within the accepted range of the general population.

The Response of Variant Histology Bladder Cancer to Intravesical Immunotherapy Compared to Conventional Cancer.

BACKGROUND: High-grade urothelial carcinomas (UCs) often show foci of variant differentiation. There is limited information in the literature about the response of these variant urothelial tumors to immunotherapy with bacillus Calmette-Guerin (BCG). We compared the response, to treatment with BCG, of UC containing glandular, squamous, nested, and micropapillary types of differentiation to response of conventional non-muscle invasive high-grade UC. METHODS: A total of 100 patients were diagnosed with variant histology urothelial cancer between June 1995 and December 2013. Forty-one patients with Ta or T1, confirmed by second look biopsies, received immunotherapy with BCG. Fourteen patients in this group were diagnosed with micropapillary differentiation, 13 patients with squamous differentiation, 9 patients with glandular differentiation, and 7 patients with nested variants. The control group included 140 patients with conventional high-grade UC. Both groups have been treated and followed similarly. FINDINGS: Patients with variant tumors had similar clinical features to patients with conventional disease, including age, male to female ratio, stage, the presence of Tis, and median follow-up. Patients with variant tumors had a significantly worse prognosis compared to patients with conventional high-grade UC, including 5-year recurrence-free survival (63.5 Vs. 71.5%, p = 0.05), 5-year progression (≥T2)-free survival (60 Vs. 82.5%, p = 0.002), 5-year disease-specific survival (73 Vs. 92.5%, p = 0.0004), and overall survival (66 Vs. 89.5%, 0.05). INTERPRETATION: A patient with variant bladder cancer treated with intravesical immunotherapy has a 27% chance of dying from this disease within 5 years compared to 7.5% chance for a patient with conventional high-grade UC.

External Validation of CROES Nephrolithometry as a Preoperative Predictive System for Percutaneous Nephrolithotomy Outcomes.

PURPOSE: We externally validated CROES (Clinical Research Office of the Endourological Society) nephrolithometry and evaluated the predictive accuracy of the nomogram. MATERIALS AND METHODS: Data were collected on patients who underwent percutaneous nephrolithotomy between January 2012 and February 2015. The CROES nomogram was applied to all patients and externally validated. The AUC and calibration plot were used for discrimination and clinical validity assessment. RESULTS: A total of 176 patients were included in study. Mean ± SD patient age was 55.2 ± 13.9 years and the mean stone burden was 640.0 ± 911.4 mm(2). The CROES nomogram was significantly associated with stone number, location and burden, and the number of implicated calyces, punctures and tracts. The postoperative treatment success rate was 85.8%. The number of stones, number of implicated calyces and CROES score were independent predictors of treatment success. The estimated AUC was 0.715 and the model provided good calibration. CONCLUSIONS: The CROES nomogram is an accurate tool to estimate renal stone complexity. CROES nephrolithometry provides great accuracy to predict postoperative efficacy.

Percutaneous nephrolithotomy for staghorn stones: Which nomogram can better predict postoperative outcomes?

PURPOSE: To identify independent predictors for postoperative stone-free status after percutaneous nephrolithotomy (PCNL) for staghorn stones and to compare Guy's, CROES and STONE nomograms regarding their predictive ability and accuracy specifically for staghorn stones. METHODS: Data of 286 patients who underwent PCNL in our department were collected and analyzed. Several parameters, including the three nomograms, were analyzed to reveal independent predictors for postoperative stone-free status. The area under the curve was used to assess the predictive ability of the independent predictors. RESULTS: A total of 73 staghorn calculi were identified with mean stone burden of 1253.5 mm(2). Mean Guy's, CROES and STONE score was 3.34, 125.8 and 9.95, respectively. Postoperative stone-free rate was 65.8 %. In univariate analysis, all three nomograms were significantly associated with stone-free status. However, STONE was the only significant independent predictor in multivariate analysis. STONE also revealed the highest predictive accuracy compared to Guy's and CROES nomogram. CONCLUSIONS: STONE nephrolithometry was found to be the only predictor for stone-free rate after PCNL for staghorn stones compared to Guy's and CROES nomograms.