Predictive factors for flexible ureterorenoscopy requirement after rigid ureterorenoscopy in cases with renal pelvic stones sized 1 to 2 cm.

PURPOSE: To evaluate the outcomes of rigid ureterorenoscopy (URS) for renal pelvic stones (RPS) sized 1 to 2 cm and to determine the predictive factors for the requirement for flexible URS (F-URS) when rigid URS fails. MATERIALS AND METHODS: A total of 88 patients were included into the study. In 48 patients, the RPS were totally fragmented with rigid URS and F-URS was not required (group 1). In 40 patients, rigid URS was not able to access the renal pelvis or fragmentation of the stones was not completed owing to stone position or displacement and F-URS was utilized for retrograde intrarenal surgery (RIRS) (group 2). The predictive factors for F-URS requirement during RIRS for RPS were evaluated. Both groups were compared regarding age, height, sex, body mass index, stone size, stone opacity, hydronephrosis, and previous treatments. RESULTS: The mean patient age was 48.6±16.5 years and the mean follow-period was 39±11.5 weeks. The overall stone-free rate in the study population was 85% (75 patients). In groups 1 and 2, the overall stone-free rates were 83% (40 patients) and 87% (35 patients), respectively (p>0.05). The independent predictors of requirement for F-URS during RIRS were male gender, patient height, and higher degree of hydronephrosis. CONCLUSIONS: Rigid URS can be utilized in selected patients for the fragmentation of RPS sized 1 to 2 cm with outcomes similar to that of F-URS. In case of failure of rigid URS, F-URS can be performed successfully in this group of patients.

Primary malignant fibrous histiocytoma of the kidney: report of a case and literature review.

We report a 44-year-old woman with a malignant fibrous histiocytoma (MFH) of the kidney. Primary renal MFH is an extremely rare tumor with a poor prognosis. Renal MFH is differentiated from renal cell carcinoma, renal sarcoma, and sarcomatoid renal tumors only by histological and immunohistochemical studies. Because the therapeutic options for MFH are different, its early diagnosis is imperative.

Does lower-pole caliceal anatomy predict stone clearance after shock wave lithotripsy for primary lower-pole nephrolithiasis?

AIM: In order to have an idea about the success rates after extracorporeal shock wave lithotripsy (SWL) in patients with lower-pole stones, we reviewed the caliceal anatomy of the patients treated in our clinic. PATIENTS AND METHODS: One hundred and ninety-eight patients having at least a 3-month follow-up period, with a single stone located in the lower pole, were included. Lower infundibulopelvic angle (LIP-A), infundibular width, and infundibular length were measured from standard intravenous urograms taken before initial ESWL. RESULTS: One hundred and thirty patients (65%) were male, and 68 patients (35%) were female. We found no impact of age, sex, and affected side on the results of ESWL. The overall stone-free rate was 61.1% after 3 months of follow-up. The stone-free rates were 47.8 and 81.4% in patients with an acute (< 70 degrees) and an obtuse (> or = 70 degrees) LIP-A, respectively (p = 0.007). Taking the infundibular width into consideration, the stone-free rates were 85.4 and 43.2% for favorable and unfavorable angles and widths (p = 0.003). However, infundibular length and stone sizes were not found to have important effects on a stone-free status (p = 0.546 and p = 0.283). CONCLUSION: We conclude that LIP-A (> or = 70 degrees) has the greatest impact on the clearance of residual fragments produced by SWL.

Effect of bladder carcinoma location on detection rates by ultrasonography and computed tomography.

OBJECTIVES: To evaluate the effect of the location of bladder carcinoma on detection rates by ultrasonography (US) and computed tomography (CT). METHODS: The study included 85 patients with bladder cancer who were examined by US and CT before cystoscopy. The bladder wall was divided into 13 separate regions, and the tumor detection rates by US and CT were calculated for each location and lesion diameter with regard to the cystoscopy findings. RESULTS: A total of 214 bladder tumors were detected at cystoscopy. The lowest detection rate for US was noted for the anteroinferior region (47%) of the bladder. The lowest detection rate for CT was also noted for the same region (55.5%). The detection rate of all anterior wall tumors by US and CT was 48.27% and 62.5%, respectively. The detection rate by CT was 100% for tumors greater than 5 mm in diameter. The greatest detection rates by both of the imaging modalities were for the bilateral side walls of the bladder. CONCLUSIONS: The results of this study suggest that bladder tumor location highly affects the detection rates by US and CT. The lowest detection rates by both modalities were noted for anterior wall tumors. Because of the lower detection rate of tumors located in the anterior wall of bladder and those smaller than 5 mm, we recommend cystoscopy whenever a bladder tumor is suspected.

Nephrostomy tract dilation using a balloon dilator in percutaneous renal surgery: experience with 95 cases and comparison with the fascial dilator system.

INTRODUCTION: Nephrostomy tract dilation is one of the important steps of percutaneous renal surgery. In this study, we present our initial experience with the balloon dilator in 95 patients and compare our results retrospectively with a group of 30 patients in whom Amplatz dilators were used. PATIENTS AND METHODS: The medical records of 95 patients who underwent percutaneous renal operations, including percutaneous nephrolithotomy and antegrade endopyelotomy, between September 1999 and September 2002 were reviewed. All procedures were performed using balloon dilators. The operative technique is the same as the other dilation procedures. Thirty consecutive patients who had previously undergone percutaneous renal surgery using the Amplatz dilators were taken as the control group and their charts were reviewed retrospectively, and the results compared with the results of patients in whom balloon dilation was used. RESULTS: There were no major perioperative complications or deaths in both groups. The mean operative time and tract formation times for the balloon dilation group and the Amplatz dilation group were 106.8 +/- 41.4 and 11.2 +/- 3.0, and 116.4 +/- 23.7 and 16.3 +/- 2.4 min, respectively. Thirteen (13.7%) patients had significant bleeding and required blood transfusion in the balloon dilation group, whereas 5 (16.6%) patients had significant bleeding in the Amplatz dilation group. Collecting system perforation due to too far advancement of the dilator occurred in 11 (11.6%) patients but there was no major parenchymal or vascular injury medially in the balloon dilation group. On the other hand, collecting system perforation occurred during sequential Amplatz dilation in 5 (16.6%) patients. CONCLUSION: We believe that the balloon system allows one-step dilation and shortens the dilation procedure. It may minimize bleeding which can occur during the stepwise fascial dilation. When using fascial dilators it is sometimes possible to go out of the collecting system by changing the size of the dilators. We think that balloon dilation may prevent these intraoperative and time-consuming situations.

Isolated renal hydatidosis: experience with 20 cases.

PURPOSE: Cystic hydatidosis is an endemic disease caused by the larval form of Echinococcus granulosus. It is mostly evident in the liver and lungs, and renal hydatidosis is uncommon. Renal hydatidosis is usually associated with other organ involvement and isolated disease is extremely rare. We present our experience with isolated renal hydatidosis in 20 patients. MATERIALS AND METHODS: The charts of 20 patients with isolated renal hydatidosis who were hospitalized in our department during a 25-year period were reviewed retrospectively. The clinical, laboratory and radiologic diagnosis, and treatment of these cases are discussed. RESULTS: The main clinical symptom was lumbar pain. There was no specific or pathognomonic laboratory test for renal hydatidosis except hydaturia, which was present only in 1 patient (5%). Of radiologic examinations computerized tomography had the highest sensitivity and specificity. Treatment was mainly surgical. We performed nephrectomy in 13 patients, and cystectomy and marsupialization in 6. One patient refused all treatments. There was no postoperative morbidity or mortality. CONCLUSIONS: Isolated renal hydatidosis is extremely rare. The main problem is the correct preoperative diagnosis. Although radiologic studies and serological-immunological tests support the diagnosis of hydatid disease, a correct preoperative diagnosis is not always easy. The treatment is mainly surgical, and with appropriate diagnosis and treatment the prognosis is good.