Comparison of Combined Guidance of Fluoroscopy and Ultrasonography in Total Tubeless Percutaneous Nephrolithotomy with the Standard Method: A Randomized Clinical Trial.

OBJECTIVE: utilizing the combination of fluoroscopy and ultrasonography during Percutaneous Nephrolithotomy (PCNL) to minimize radiation exposure. METHODS: In this randomized clinical trial, 118 patients with urinary stones who were candidates for PCNL surgery in the prone position were selected and divided into two groups (with an allocation ratio of 1:1). Cases were grouped according to whether ultrasonography was used for renal tract dilation and Amplatz sheath placement. The number of attempts to establish proper renal access, the time interval between access to the targeted calyx and nephroscope entrance, and the Clavien-Dindo score were collected. RESULTS: The mean age of all patients was 46.12±11.28 (45.6±11.2 in the total fluoroscopy group and 46.5±11.4 in the combined group) years (20-66). The intergroup differences in the baseline features were not significant. The mean duration of fluoroscopy time was significantly reduced in the combined guidance group (36.22±10.73 vs. 23.05±8.94 seconds, [P-value = 0.001]). Moreover, the difference in the distribution of Amplatz location on the nephroscopy time was meaningful (P-value = 0.016). However, intergroup differences in the number of attempts to successful puncture, length of hospitalization, recovery time, and postoperative complications, including gross hematuria duration, blood loss volume, pack cells requirement, pain score immediately and 6 hours after the surgery, and Clavien-Dindo score were not meaningful. CONCLUSION: It can be concluded that the use of ultrasound with X-ray in prone PCNL compared to the use of X-rays alone can significantly reduce the duration of radiation without increasing the risk of intra-operative and postoperative detrimental events.

The lack of correlation between mast cells and microvessel density with pathologic feature of renal cell carcinoma.

OBJECTIVE: The growth of solid tumors requires angiogenesis. Evidence indicates that mast cells (MCs) play an important role in tumor angiogenesis but results are not definitive. The aim of this study is to investigate the possible effects of angiogenesis and the presence of MCs on the prognosis of renal cell carcinoma (RCC). PATIENTS AND METHODS: The study involved 40 patients with RCC (24 men and 16 women who were treated with radical nephrectomy between 1995 and 2006, at our institution. The routine mast cell tryptase staining method was used to assess the MCs in both normal tissue and tumoral tissue. The immunohistochemical staining for CD34 antigen was used for determination of microvessel density. The relation between MC count and tumor status such as tumor stage, size, grade, and other clinicopathologic parameters in RCC were evaluated in this study. RESULTS: We found no relationship between the number of MCs and patient age, sex, tumor stage, grade, size. No association was noted between angiogenesis and either patient sex or age, tumor size, stage, and grade. No statistically significant correlation was found between the number of MCs and microvessel density in RCC (P-value = 0.45) but the max value of MCs and MVD were in clear cell carcinoma. CONCLUSIONS: The MC count was not associated with tumor status such as tumor stage, size, grade, and other clinicopathologic parameters, however, MCs may be related to tumor angiogenesis and acceleration of tumor growth in RCC and therefore need further evaluation in RCC.