Comparison of retrograde ureterorenoscopy (URS) and percutaneous anterograde ureteroscopy for removal of impacted upper ureteral stones >10mm in the elderly population.

PURPOSE: We aimed to compare the success and complication rates of the anterograde and retrograde Ureterorenoscopy (URS) for impacted upper ureteral stones in patients > 65 years of age. MATERIALS AND METHODS: Data of 146 patients >65 years of age and underwent anterograde URS (n=68) in supine position or retrograde URS (n=78) for upper ureteral impacted stones>10 mm between January 2014 and September 2018 were collected prospectively. The groups were compared for success and complication rates, duration of operation, hospital stay, and ancillary procedures. RESULTS: Anterograde and retrograde URS groups were similar for demographic and stone related characteristics. The success rate of the anterograde URS group was significantly higher than the retrograde URS group (97.1% vs. 78.2%, p=0.0007). The complication rates were similar for the two groups (p=0.86). Clavien grade I and II complications were observed in 3 patients in each group. The mean hemoglobin drop was 0.5 g/dL in the anterograde URS group and blood transfusion was not performed in any of the patients. The mean duration of operation was 41.2±12.5 minutes in the mini-PNL group and 59.6±15.1 minutes in the RIRS group and the difference was statistically significant (p=0.02). The median duration of hospitalization was 1 day for both groups. CONCLUSIONS: Performing anterograde URS in supine position provided better success rates and similar complication rates compared to retrograde URS. Based on these results anterograde URS shall be considered as one of the primary treatment options for management of impacted upper ureteral stones in the elderly population.

Reliability and validity of Turkish versions of the interstitial cystitis symptom index and interstitial cystitis problem index.

AIM: To validate the Turkish versions of the interstitial cystitis symptom index (ICSI) and interstitial cystitis problem index (ICPI) for use in Turkish speaking patients with bladder pain syndrome/interstitial cystitis (BPS/IC). METHODS: After translation of the original ICSI and ICPI into the Turkish language, Turkish versions of ICSI and ICPI were self-administered to all participants. Test-retest reliability (intraclass correlation coefficient) was evaluated at 2 weeks intervals in the BPS/IC group. Internal consistency was evaluated using Cronbach's alpha. Scores of ICSI and ICPI was compared between BPS/IC and control groups to examine discriminant validity. Criterion validity was examined via investigating the correlations between bladder diary data (24-hour frequency and nocturia), visual analogue scale (VAS) scores, and results to the corresponding questions in ICSI and ICPI. RESULTS: Results of 79 patients with BPS/IC and 50 control patients were analyzed. Both indices showed high internal consistency (Cronbach's α for ICSI and ICPI was 0.879 and 0.923, respectively). The test-retest reliability of ICSI and ICPI was high for total scores and subdomains of both indices (intraclass correlation coefficient was 0.722 for ICSI and 0.777 for ICPI). Scores of both indices were significantly higher in BPS/IC group than the control group (P < .001). Statistically significant correlations were found between 24-hour frequency, nocturia, VAS scores, and corresponding questions in the indices. A statistically significant and strong correlation was observed between ICSI and ICPI scores (P < .001, rS = .632). CONCLUSION: Turkish versions of ICSI and ICPI are reliable, consistent, and valid instruments to evaluate symptoms of Turkish speaking patients with BPS/IC.

The role of a novel decision aid to support informed decision making process in patients with a symptomatic non - lower pole renal stone < 20 mm in diameter: a prospective randomized study.

OBJECTIVES: To evaluate the efficacy of a novel decision aid (DA) in improving the patients' level of knowledge and decreasing decisional conflicts while deciding for SWL vs. RIRS in case of a symptomatic renal stone < 2 cm. MATERIALS AND METHODS: In this prospective randomized study patients were randomized to receive either standard informing process (group 1, n=57) or DA (group 2, n=58). Level of knowledge was assessed with a questionnaire of 10 questions before and after patient informing process. Level of decisional conflict was assessed with a previously validated scoring system. Logistic regression analysis was performed to identify factors associated with adequate level of knowledge. RESULTS: Level of knowledge increased significantly in both groups after patient informing process. The increase was significantly more prominent in group 2 (p=0.045). Percentage of patients with adequate knowledge was also higher in group 2 (56.1%vs.74.1%, p=0.04). Mean decisional conflict scale score (higher score indicates higher decisional conflict level) was also significantly higher in group1 (14.7±14.5 vs. 10.1±13.7, p=0.045). Multivariate logistic regression analysis revealed higher education level (college degree) and use of DA as factors associated with adequate level of knowledge. CONCLUSIONS: In the current study, The DA was shown to have a positive impact on level of knowledge and diminish the level of decisional conflict for patients with a symptomatic non-lower pole renal stone < 20 mm. We recommend development and use of DAs for particular clinic scenarios to aid in education of patients and shared decision making process in stone disease clinics.

Significance of second transurethral resection on patient outcomes in muscle-invasive bladder cancer patients treated with bladder-preserving multimodal therapy.

PURPOSE: Although the role of second transurethral resection of bladder tumor (TURB) is well established in high-risk non-muscle-invasive bladder cancer, to the best of our knowledge, there is no study regarding the role of a second transurethral resection (TUR) after a complete first TURB in multimodal therapy (MMT). The aim of this study was to evaluate the role of a second TUR on disease-specific survival (DSS) and overall survival (OS) rates in muscle-invasive bladder cancer (MIBC) patients who were treated with MMT. METHODS: We assessed the data of 90 patients (stage T2-4, N0-1, M0 urothelial cancer) who were treated with MMT at our clinic between January 2000 and June 2014. Patients with incomplete initial TURB were excluded. A total of 43 patients had a second TUR before starting radiochemotherapy of MMT (group 1), and 47 patients (group 2) were treated with MMT without having a second TUR. The impact of second TUR on DSS and OS rates was the primary outcome measure of the study. RESULTS: Mean (SD, range) age and mean follow-up of the patients were 65.1 (7.1, 52-81) years and 60.3 (38.3, 6-159) months, respectively. The two groups were similar with regard to sex, age, presence of hydronephrosis, lymph node involvement and stage. The 5-year DSS rate was better in group 1 compared to group 2 (68 vs. 41 %) (p = 0.046). The 5-year OS rates of the patients were 63.7 and 40.1 % in groups 1 and 2, respectively (p = 0.054). Multivariate analysis revealed that second TUR, lymph node involvement, presence of hydronephrosis and tumor stage were independent prognostic factors for DSS. CONCLUSIONS: Second TUR should be performed in patients with MIBC who are going to be treated with bladder-preserving MMT protocols.

Is there a role of the enhancement degree of the lesion on computerized tomography for the characterization of renal tumors?

PURPOSE: We determined the role of tumor enhancement on dynamic enhanced computerized tomography for differentiating pathological characteristics. MATERIALS AND METHODS: A total of 149 patients with renal tumor underwent dynamic enhanced computerized tomography at our university from June 2007 to November 2011. Tumors were treated surgically and pathological evaluation was done. Precontrast and postcontrast HU values, and the difference were recorded. Postcontrast HU evaluations were done at the nephrographic phase of the procedure. Tumor HU values were compared according to histological subtype, tumor grade and pathological stage. RESULTS: Mean ± SD patient age was 57 ± 13 years and mean tumor size was 4.8 ± 2.7 cm. Postcontrast HU and contrast difference values were significantly lower in the malignant group. A cutoff HU value of 138 HU (mean AUC 0.893 ± 0.027, 95% CI 0.84-0.94) differentiated renal cell cancer from oncocytoma with 88% sensitivity and 87% specificity. Low and high grade cases demonstrated similar precontrast and postcontrast HU, and contrast difference values. These enhancement parameters were significantly lower for higher stage (pT2-3) renal cell cancer than for pT1. We detected higher postcontrast values (mean 62 ± 14 vs 56 ± 39 HU, p = 0.011) and contrast difference values (mean 92 ± 15 vs 82 ± 42 HU, p = 0.034) for high grade than for low grade renal cell cancer in patients with tumors 4 cm or less. CONCLUSIONS: The degree of enhancement on computerized tomography helps differentiate tumor characteristics. These outcomes may help the clinician with prognostic evaluation and may augment the role of computerized tomography in therapeutic planning.

Does the number of cycles of cisplatin based chemotherapy have any effect on renal function in patients with testicular germ cell tumor?

PURPOSE: We assessed the effects of the number of cisplatin, etoposide and bleomycin cycles on long-term renal function. MATERIALS AND METHODS: A total of 157 patients with primary testicular germ cell tumors were treated between 1995 and 2013, of whom 113 (72%) received chemotherapy as the primary intervention. Data were collected retrospectively. The estimated glomerular filtration rate was determined using the Modification of Diet in Renal Disease (MDRD) formula based on pretreatment and last followup visit serum creatinine measurements. Patients who did not receive chemotherapy were compared to those who received cisplatin based chemotherapy. The chemotherapy group was also divided into 3 subgroups according to the number of chemotherapy cycles (2, 3, or 4 or more). RESULTS: At the last followup visit serum creatinine and the estimated glomerular filtration rate significantly differed between the chemotherapy and nonchemotherapy groups. The decrease in the median estimated glomerular filtration rate was significantly greater in the chemotherapy than the nonchemotherapy group (p<0.001). New onset stage 3 chronic kidney disease was observed in 19 patients (12.1%) in the chemotherapy group, including 0%, 5.9%, 13.8% and 20.9% who received 0, 2, 3, or 4 or more chemotherapy cycles, respectively. Except for the difference between the nonchemotherapy group and the 2-cycle chemotherapy group the differences between the groups in new onset chronic stage 3 kidney disease were statistically significant. CONCLUSIONS: Patients with testicular tumors who received cisplatin based chemotherapy showed a significant decrease in the estimated glomerular filtration rate and a significant increase in new onset stage 3 chronic kidney disease compared to patients who received no cycle. However, in patients at high risk with stage I nonseminomatous germ cell tumor who elected 2 cycles of cisplatin, etoposide and bleomycin the chemotherapy had no statistically significant effect on these parameters compared to those in patients who received no chemotherapy.

Time between first and second transurethral resection of bladder tumors in patients with high-grade T1 tumors: is it a risk factor for residual tumor detection?

PURPOSE: We evaluated the risk factors for residual tumor detection after transurethral resection of bladder tumors (TURBT) in patients with newly diagnosed high-grade T1 transitional cell carcinoma of the bladder. PATIENTS AND METHODS: Overall 132 patients underwent TURBT for primary bladder tumors and were diagnosed as high-grade T1 bladder cancer. Patients with incomplete resections were excluded from the study. Clinical and pathologic characteristics of the patients were compared and multivariate analysis was performed to determine independent prognostic factors. RESULTS: Residual tumor was demonstrated in 57 (43.1%) of the patients. The residual tumor rate was significantly lower in patients with solitary tumors, tumors <3 cm in diameter, muscle presence in the initial TURBT pathologic sample and treated by an expert surgeon. In patients with solitary bladder tumors, tumors at the dome and posterior wall of the bladder exhibited higher rates of residual tumor (p < 0.0001). The time elapsed between first and second TURBT was significantly shorter in patients without residual tumor compared to patients with residual tumor at second TURBT (32.6 ± 9.1 vs. 39.3 ± 10.9 days, respectively, p = 0.001). Multivariate analysis demonstrated that time elapsed between first and second TURBT is the most important parameter for residual tumor detection. CONCLUSION: Our study revealed that multiple tumors, tumors >3 cm in size, absence of detrusor muscle in the initial TURBT specimen, TURBT performed by trainees and finally, as a new finding, prolonged interval between first and second TURBT are independent predictors for residual tumor detection in patients with high-grade T1 tumors.

Reliability of frozen section examination of obturator lymph nodes and impact on lymph node dissection borders during radical cystectomy: results of a prospective multicentre study by the Turkish Society of Urooncology.

OBJECTIVE: To evaluate the accuracy of frozen section examination (FSE) for detecting lymph node (LN) metastases and whether we can use this information to decide the extent of LN dissection during cystectomy. PATIENTS AND METHODS: From August 2005 to August 2009 FSE of obturator LNs was performed in 118 patients with bladder cancer, who were undergoing radical cystectomy with extended LN dissection. Removed tissues from 12 well defined LN regions were sent separately for pathologic evaluation. The FSE results of obturator regions were compared with the final histopathologic results of these node regions. RESULTS: The mean number of removed nodes per patient was 29.4 ± 9.3 (median 28, range 12 to 51). The sensitivity, specificity, positive and negative predictive values of FSE for the 118 right obturator LN regions were 94.7%, 100%, 100% and 99%, respectively. The same values for the 118 left obturator LN regions were 86.7%, 100%, 100% and 98.1%, respectively. At final pathologic examination 28 of 118 (23.7%) patients had LN metastasis at obturator regions. Skipped metastasis was found in 15/90 patients (16.7%). Clinical and pathological stage of the primary tumour were found to be significant parameters for skipped metastasis (P = 0.008 and P < 0.001, respectively). CONCLUSIONS: Performing FSE of the obturator LNs seems to be a reliable procedure for their evaluation with acceptable negative and positive predictive values. The information obtained with FSE of obturator LNs can be used to determine intraoperatively the extent of LN dissection, especially in patients with significant comorbidity. Our study also showed that if the clinical stage of the primary tumour is < cT2, the possibility of skipped metastasis is zero.

Comparison of radical and partial nephrectomy in terms of renal function: a retrospective cohort study.

OBJECTIVE: This study aimed to evaluate kidney function following radical or partial nephrectomy and to evaluate the role of two common chronic diseases, hypertension (HT) and diabetes mellitus (DM), on glomerular filtration rate (GFR) in the long term. MATERIAL AND METHODS: Data on 488 patients who underwent surgery for renal tumours between 1994 and 2008 were investigated. Patient characteristics and estimated GFR, history of DM or HT, tumour size and new-onset decrease in GFR were recorded. Multivariable Cox proportional hazards regression was used to investigate whether the two types of operation were associated with chronic kidney failure after surgery, and the outcome was adjusted for age, gender, HT, DM and tumour size. p Values less than 0.05 was regarded as significant. RESULTS: Seventeen patients (18.9%) in group 1 and 176 (68%) in group 2 developed new onset of GFR < 60 ml/min/1.73 m(2). Three patients (2.9%) in group 1 and 137 (37.2%) in group 2 developed new onset of GFR < 45 ml/min/1.73 m(2) (p < 0.05). HT was associated with new-onset chronic renal failure in the radical nephrectomy group (hazard ratio 1.39, 95% confidence interval 1.028-1.890). CONCLUSION: After surgical treatment of renal masses, patients are at risk for development of chronic renal failure. A decrease in GFR was detected in both partial and radical nephrectomy, the latter associated with increased risk, especially in hypertensive patients. Routine praxis of radical nephrectomy should be overviewed.

Squamous cell carcinoma of the bladder associated with chronic irritation related to a migrated intrauterine device.

Intrauterine devices (IUDs) are one of the most commonly used methods for reversible contraception. This article reports a case of squamous cell carcinoma of the bladder which exhibited a migrated IUD into the bladder. A 66-year-old woman with a 26-year history of IUD use admitted to the clinic with the chief complaint of intermittent macroscopic haematuria. Clinical examination raised a suspicion bladder carcinoma, so cystoscopy and histological sampling were performed and squamous cell carcinoma of bladder was diagnosed, which was related to chronic irritation by a migrated IUD.

Potassium sensitivity test predicts hydrodistention efficacy in patients with bladder pain syndrome/interstitial cystitis.

OBJECTIVE: To determine the possible role of potassium sensitivity test (PST) in predicting the success of hydrodistention (HD) in patients with bladder pain syndrome/interstitial cystitis (BPS/IC). MATERIAL AND METHODS: Patients who underwent PST before diagnostic cystoscopy and HD were evaluated to collect data regarding the visual analog score (VAS) to assess pain, the voiding diary for frequency of urination/nocturia, mean urine volume per void, interstitial cystitis symptom index, and problem index before HD. Patients were requested to provide the VAS of pain at 1 month and 6 months post-HD. A reduction 2 or more on the VAS of pain was considered as a response adequate to be noted. RESULTS: The median age of the patients was 46 years. The PST was positive for 27 patients (27/39; 69.2%). At 1 month post-HD, out of the 27 patients with positive PST, 23 (85.2%) were found to have been responsive to HD and 4 (14.8%) were non-responsive. Of the 12 (12/39; 30.8%) patients who showed a negative PST, 7 (58.3%) were non-responsive and 5 (41.7%) were responsive to HD. A logistic regression analysis revealed that PST (p=0.009) was the only parameter that was able to predict HD efficacy at 1 month post-HD. CONCLUSION: PST was found to be a predictive factor for the short-term efficacy of HD. BPS/IC patients with positive PST are likely to be more susceptible to the damage of mucosal afferent nerve endings, which results in them benefiting from HD to a greater degree.

Effectiveness of antibiotics given to asymptomatic men for an increased prostate specific antigen.

PURPOSE: Although there is controversy surrounding this subject, some urologists in daily practice often prescribe antibiotics before biopsy to men with a newly increased prostate specific antigen. We evaluated the effects of antibiotics on serum total prostate specific antigen, free prostate specific antigen, percent free prostate specific antigen and prostate specific antigen density in men with prostate specific antigen between 4 and 10 ng/ml and normal digital rectal examination. We also investigated the incidence of prostate cancer after antibiotic treatment by performing prostate biopsies in all patients regardless of posttreatment prostate specific antigen. MATERIALS AND METHODS: Between May 2006 and April 2008 a total of 100 men with total prostate specific antigen between 4 and 10 ng/ml were enrolled in this study. In addition to total prostate specific antigen, free prostate specific antigen, percent free prostate specific antigen and prostate specific antigen density values were evaluated for all of the patients. Patients with pathological digital rectal examination and urinalysis were excluded from the study. All patients received 400 mg ofloxcacin daily for 20 days. After treatment the patients were reevaluated. Regardless of the total prostate specific antigen value after therapy transrectal ultrasound guided prostate biopsy was performed. RESULTS: Overall 23 men (23%) had histologically proven prostate cancer on biopsy. Mean total prostate specific antigen, free prostate specific antigen and prostate specific antigen density decreased after treatment in patients with and without prostate cancer. However, these reductions within these parameters were not significantly different between patients with and without prostate cancer. Only percent free prostate specific antigen change after treatment was found to be significantly different between patients with and without prostate cancer (p = 0.015). In 17 of the 100 men total prostate specific antigen after treatment was less than 4 ng/ml and of these 5 (29.4%) had prostate cancer on biopsy. CONCLUSIONS: Although antibiotic therapy will decrease serum total prostate specific antigen, it will not decrease the risk of prostate cancer even if the prostate specific antigen decreases to less than 4 ng/ml. Therefore, prescribing antibiotics for asymptomatic men with a newly increased prostate specific antigen may not be an appropriate method of management.

The prognostic significance of advanced age in patients with bladder cancer treated with radical cystectomy.

OBJECTIVE: To evaluate the association of patient age with pathological and long-term oncological outcomes after radical cystectomy (RC) for bladder carcinoma, as this disease, like many others, increases in incidence with age. PATIENTS AND METHODS: We retrospectively reviewed 241 consecutive patients with invasive bladder cancer who had RC between 1990 and 2007. The age at RC was analysed both as a continuous and categorical (< or =50 years, 38 patients; 51-69, 172; or > or =70, 31) variable. Survival was also analysed. RESULTS: Increasing age, analysed as a continuous and categorical variable, was associated with advanced pathological stage (P = 0.009 and 0.006, respectively). The 5-year cancer-specific survival rates for patients according to the age groups were 78.5%, 44.9% and 28.1%, respectively, and Kaplan-Meier analysis showed an increased risk of bladder cancer-specific death with advancing age (P < 0.001). Being older at RC was an important prognostic factor for disease-specific survival in a multivariate Cox regression model. Patients aged > or =70 years had a significantly higher risk of disease than patients aged < or =50 years (P = 0.002). CONCLUSIONS: Higher age at RC is significantly associated with the risk of pathologically advanced disease and poorer cancer-specific survival. More prospective work is needed to examine the impact of age on tumour biology and cancer-specific survival.

Prognostic significance of hydronephrosis in bladder cancer treated by radical cystectomy.

OBJECTIVES: Hydronephrosis is a common finding in patients with bladder cancer. This study aims at an analysis of the association between hydronephrosis, pathologic characteristics of bladder cancer and cancer-specific survival rate after radical cystectomy. METHODS: Clinical data of 241 patients who underwent radical cystectomy between 1990 and 2007 for invasive bladder cancer were analyzed retrospectively. The significance of the relation between the clinical and pathological findings were determined by the chi(2) test. The Kaplan-Meier test was used for the estimation of disease-specific survival obtained according to hydronephrosis, and the differences were examined by the log-rank test. Multivariate analysis was performed by the Cox regression model. RESULTS: Of 241 patients, 39 (16.2%) had unilateral and 13 (5.4%) bilateral hydronephrosis. Five-year cancer-specific survival rates were reported as 63.4% in non-hydronephrotic and 11.57% in hydronephrotic patients (log-rank test, p < 0.001). The presence of hydronephrosis was associated with advanced pT stage, higher tumor grade and lymph node metastases (p < 0.001, p < 0.001 and p < 0.001, respectively). Multivariate analysis showed that hydronephrosis is an important factor directly affecting cancer-specific survival (0.0264). CONCLUSIONS: The presence of hydronephrosis prior to radical cystectomy is a significant prognostic parameter, associated with poor cancer-specific survival and advanced disease stage.

Combined Robotic-assisted Laparoscopic Radical Prostatectomy and Partial Nephrectomy, Rare Coincidence.

The incidence of second primary cancer detection in patients with prostate cancer undergoing cross-sectional imaging for staging workup is 1.5%.1 Concomitant prostate cancer and clear-cell renal cell carcinoma is a rare condition. The coexistence of 2 synchronous neoplasm is highly infrequent. In this case, we present a combined robot-assisted operation for both procedures concurrently with a port strategy allowing reuse of ports.

Effect of Treatment Modality on Long Term Renal Functions in Patients With Muscle Invasive Bladder Cancer.

PURPOSE: To compare of changes in glomerular filtration rate (GFR) in patients who underwent radical cystectomy (RC) and multimodal treatment (MMT). MATERIALS AND METHODS: We identified 472 consecutive patients who underwent RC or treated with MMT for muscle invasive bladder cancer (MIBC) at our institution, between January 1995 and December 2010. After ex-cluding the patients who died within 5 years or without 5 years of follow-up, 175 and 59 patients who were treated with RC and MMT, respectively were included to the study. GFR was measured before treatment and every 6 months after treatment till the end of 60th month. RESULTS: The mean age and mean baseline GFR were 66.5±5.7 years and 85.1±18.2 mL/min/1.73m2, respectively for all patients. We detected statistically significant higher decrease rates for GFRs in MMT group compared to RC group at every follow up period till 42nd month. Renal function decreasing was found to be more prominent during first year of follow-up (79.1 to 65.9 mL/min/1.73m2) in MMT group. However, GFR decreased more reg-ularly in RC group (~4 mL/min/1.73m2 per year). MMT, lower baseline GFR, Diabetes Mellitus, hypertension, and ureteroenteric anastomotic stricture development were associated with low GFR under 60 and 45 mL/min at the end of five years. CONCLUSION: Decreased renal function is noted in many MIBC patients after RC or MMT in the long-term fol-low-up. Renal function deterioration is more prominent within the first year after MMT.

The Effect of Time to Castration Resistance on Overall Survival and Success of Docetaxel Treatment in Castration Resistant Prostate Cancer Patients.

PURPOSE: To investigate the prognostic role of time to castration resistance(TTCR) in patients who have received solely Docetaxel chemotherapy regimen(DCR) for castration resistant prostate cancer(CRPC). METHODS: Between Jan 2004 and Dec 2015, data of 162 patients who have received DCR for CRPC were gath-ered. Patients were divided into three groups according to TTCR: Group 1(? 12 months), group 2(13-24 months), and group 3(>24 months). Data of age, clinical stage, Gleason grade(GG), previous treatments, site of metastases, Prostate-specific antigen (PSA) values, TTCR, overall survival, biochemical progression free survival(PFS) and PSA response to docetaxel were recorded. RESULT: The mean age of the 162 patients was 74.4 ± 8.5 years. Data on mean age, type of castration, adding estra-mustine to docetaxel, secondary hormonal manipulation, Gleason grade, clinical T stage at initial diagnosis and site of metastases were comparable between three groups. PSA values were higher in group 1 than other groups. PSA response to docetaxel was 59.2% in all patient and it was worse in group 1 than other groups (P = .009). Two years overall survival rates were 7.6%, 25% and 32.3% in group 1, 2 and 3, respectively. Median survival rates were 7, 14 and 23 months in group 1, 2 and 3, respectively, and this difference was statistically significant (P=.016). On multivariate analysis, TTCR was found to be independent prognostic factor for overall survival and response to docetaxel treatment. CONCLUSION: TTCR appears to be an independent prognostic factor for patients who are candidates for DCR.

Does renal capsular invasion have any prognostic value in localized renal cell carcinoma?

PURPOSE: We evaluated the impact of renal capsular invasion without perirenal fat invasion in the outcome of patients with localized renal cell cancer treated surgically. MATERIALS AND METHODS: We retrospectively reviewed the records of 249 consecutive patients with localized renal cell cancer (pT1-pT2N0M0) who underwent partial or radical nephrectomy between 1995 and 2007. Pathological staging was done according to the 2002 TNM staging system. Association of clinical and pathological parameters with capsular invasion was determined using the chi-square test. Kaplan-Meier estimations of disease specific survival were generated according to capsular invasion and the log rank test was used to compare survival according to the variable. RESULTS: Renal capsular invasion was detected in 79 of the 249 patients (31.7%). Of the patients 19 of 96 (19.8%) with pT1a, 26 of 87 (29.9%) with pT1b and 34 of 66 (51.1%) with pT2 had renal capsular invasion. Tumor diameter and high grade were associated with renal capsular invasion (p <0.05). Mean followup was 40.7 months. Five-year disease specific survival in patients with and without capsular invasion was 92.7% and 90.4%, respectively (p >0.05). In pT1a, pT1b and pT2 cases differences in Kaplan-Meier estimations according to renal capsular invasion were statistically insignificant (p >0.05). On multivariate analysis renal capsular invasion was not detected as an independent prognostic factor for disease specific survival (HR 0.6582, p = 0.5373). CONCLUSIONS: Tumor diameter and high grade were associated with renal capsular invasion in stage pT1-2 renal cell cancer. However, capsular invasion did not have any independent impact on patient survival.

Computerized tomography for detecting perivesical infiltration and lymph node metastasis in invasive bladder carcinoma.

OBJECTIVES: Computerized tomography (CT) is used in the preoperative staging of invasive bladder carcinoma. We evaluated the role of CT for detecting perivesical invasion and lymph node metastases in patients who had undergone radical cystectomy and pelvic lymphadenectomy for invasive bladder carcinoma. PATIENTS AND METHODS: We retrospectively analyzed the clinical and pathological data of 100 patients with invasive bladder carcinoma who had undergone radical cystectomy. The preoperative CT images were reevaluated and interpreted by one uroradiologist blinded to the final pathological results for evidence of extravesical tumor extension or lymph node metastases. RESULTS: Of the 100 patients, CT showed extravesical tumor involvement in 57. Of these 57 cases, 22 displayed no evidence of extravesical tumor involvement in the final pathological analysis. In 6 cases, although perivesical invasion was identified in the final pathological analysis, preoperative CT showed no evidence of extravesical tumor involvement. Regarding extravesical tumor spread, the differences between CT and pathological stages were statistically significant (p < 0.001). CT was highly suggestive of lymph node metastases in 9 cases, but only 4 were pathologically confirmed. On the other hand, in 9 patients pelvic lymph node metastasis were pathologically diagnosed, but there was no evidence of lymphadenopathy on CT. Regarding lymph node involvement, there was moderate concordance between CT and pathological findings (p = 0.003, kappa = 0.29 +/- 0.14). CONCLUSION: CT has limited accuracy in detecting perivesical infiltration and lymph node metastasis in invasive bladder carcinoma. The information provided by CT is insufficient and we urgently need more reliable staging techniques.

Prospective evaluation of kidney displacement during supine mini-percutaneous nephrolithotomy: Incidence, significance, and analysis of predictive factors.

INTRODUCTION: Kidney displacement may alter the quality of renal puncture during percutaneous nephrolithotomy (PCNL). The aim of this study was to identify the rate of kidney displacement and parameters associated with kidney displacement in patients who underwent supine mini-PCNL. METHODS: Data of 98 consecutive patients who underwent mini-PCNL was collected prospectively. The patients were grouped as displacement-positive vs. -negative. The parameters collected were age, gender, body mass index, side of the kidney, punctured calyx, fluoroscopy time to successful puncture and tract dilation, stone-free and complication rates, stone diameter, length of the renal artery, and quantity of peri-renal and abdominal fat. Groups were compared for the above listed parameters and logistic regression analysis was performed to identify factors associated with kidney displacement. RESULTS: There were 34 and 64 patients in the displacement-positive and -negative groups, respectively. Groups were similar for stone-free and complication rates. Fluoroscopy time to puncture and tract dilation were longer in the displacement-positive group. Groups were different for renal artery length and peri-renal fat measurements. In multivariate analysis, lower pole puncture, renal artery length, and peri-renal fat measurement were found to be independent predictors of kidney displacement. CONCLUSIONS: Kidney displacement does not alter the success and complication rates, but is associated with longer fluoroscopy times during supine PCNL. In the current study, parameters in preoperative non-contrast computerized tomography (NCCT) associated with kidney displacement were identified. We recommend surgeons evaluate and take into account these parameters during preoperative planning to establish better outcomes and diminish fluoroscopy times.