Percutaneous nephrolithotomy should be performed by an experienced endourologist in patients at risk for severe bleeding, such as those with a solitary kidney or staghorn stones.

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The aim of this work was to evaluate the clinical feasibility of diffusion-weighted (DW) MRI in detection and staging of urinary bladder tumour and to compare DW MRI with the T(2)-weighted technique. One hundred and six patients with bladder tumour were prospectively included in our study. All patients were evaluated with MR imaging. We started with axial T(2)-weighted high resolution MR of the urinary bladder, then DW MRI. Two radiologists independently interpreted the MR images, and discrepancies were resolved by consensus. The accuracy of DW MRI in staging of bladder tumour was evaluated using the final histopathological findings. In DW imaging (DWI) staging accuracy was 63.6% and 69.6% in differentiating superficial from invasive tumours and organ-confined from non-organ-confined tumours, respectively. On a stage by a stage basis, DWI accuracy was 63.6% (21/33), 75.7% (25/33), 93.7% (30/32) and 87.5% (7/8) for stages T1, T2, T3 and T4, respectively. In the T(2)-weighted technique, the overall staging accuracy was only 39.6% and accuracy for differentiating superficial from invasive tumours and organ-confined from non-organ-confined tumours was 6.1% and 15.1%, respectively. DW is superior to T(2)-weighted MRI in staging of organ-confined tumours (< or =T2) and both techniques are comparable in the evaluation of higher-stage tumours.

What ' s known on the subject? and What does the study add? Shock wave lithotripsy and fl exible ureterorenoscopy are acceptable treatment options for lower pole stones smaller than 10 mm, while percutaneous nephrolithotomy is the favoured treatment for stones larger than 20 mm.

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