Background: Percutaneous nephrolithotomy was usually practiced in prone position. However, there is a recent shift towards supine position. This shift needs a continuous practice to increase the surgeon's learning curve. Aims: To give an insight into the learning curve of a single surgeon, capable of doing percutaneous nephrolithotomy in the conventional prone position, during his transition to the supine one using different indicators. Materials and Methods: This study included 80 procedures, equally divided into 4 groups and the following endpoints were recorded and compared among groups: operation and fluoroscopic screening times, volume of the irrigant fluid consumed, postoperative length of hospital stay, stone clearance rate and procedure related morbidity. Results: The mean operation and fluoroscope screening durations showed a statistically significant decline with time. The operative time drop from 117 minutes at the beginning to about the half [60 minutes] after sixth months and working with 80 patients. The fluoroscopy time declined from 3.5 minutes at the beginning to 1.5 minute at the end. Our stone clearance rate continued to improve among groups [with advancement of learning curve] [P = 0.034] without approaching the plateau. Also for other indicators [volume of the irrigant fluid consumed, postoperative length of hospital stay and complications], all showed statistical significant reduction with increased learning curve [P < 0.0001]. Conclusions: Operative time and stone clearance rate continued improvement with increasing learning curve. However, the volume of irrigation fluid, rate and grade of complications and length of postoperative stay reached its plateau after 40 procedures.
Background: Urothelial carcinomas [UCs] can be diagnostically challenging, particularly transurethral bladder tumors resection biopsies with limited material. Immunohistochemistry is a valuable instrument for diagnosis when morphology alone is inadequate. GATA-binding protein 3 [GATA3] and cytokeratin 5/6 [CK 5/6] contributes to the growth of UC. However, their correlative expression in UC and prognostic value has not been sufficiently investigated.
The aim of the work:The current study aimed to evaluate the utility of GATA3 expression in UC and correlate that with CK 5/6 expression to verify different subtypes of UC and assess their prognostic significance.Methodology: Here, we immunohistochemically stained GATA3 and CK 5/6 in 90 UCs samples by transurethral bladder tumor resection in a retrospective study, between May 2018 and February 2020. All were histopathologically evaluated and immunohistochemically stained for GATA3 and CK 5/6, and then correlated them with the clinicopathological parameters to investigate their clinical significance.Results: GATA3 expression was seen in 76 patients [84.44 %]. There was significant correlation between GATA3 expression with the tumor histological grade and degree muscle invasion. There was a weak or even negative expression in high-grade, invasive than the low-grade, non-invasive tumor [P= <0.001]. CK5/6 was positive and focally positive in 27.78% with a significant correlation of CK5/6 expression with tumor grade and muscularis propria invasion. On the other side, tumors with diffuse GATA3 expression had low CK5/6 expression.
Conclusion:GATA3 and CK 5/6 should be used as sensitive and specific markers for UC. They can also be effectively used in the prediction of probable grade and tumor invasion in biopsied material with poor morphological characters; and thus, help in the future appropriate treatment.
Background: Transurethral resection (TUR) followed by adjuvant therapy is still the treatment of choice of Non-Muscle-Invasive Bladder Urothelial Carcinoma (NMIBUC). However, recurrence is one of the most troublesome features of these lesions. Early second resection and adjuvant BCG therapy has been shown to improve the outcome. Objective: To evaluate the prognostic value of C-erbB-2 (HER2/neu) expression status in Non-Muscle-Invasive Bladder Urothelial Carcinoma cases, before and after intravesical Bacillus Calmette Guerin (BCG immunotherapy). Materials and methods: HER2/neu expression was studied in 120 (Ta-T1) Non-Muscle-Invasive Urothelial Carcinoma cases. The expression was evaluated and compared to the expression after Bacillus Calmette Guerin (BCG) immunotherapy. Results: HER2/neu expression in low and high grade of the Non- Muscle-Invasive Urothelial Carcinoma was (38%) and (83%) respectively. The difference of the expression rates by tumor grade was statistically significant. In recurring lesions post BCG therapy, C-erbB-2 expression was markedly decreased (31.6%) when compared to its expression before therapy (65%). Conclusions: The HER2/neu expression increased as the tumor grade rose. The reduction in expression following BCG treatment in Non-Invasive transitional cell carcinoma cases could reflect a reduction of the potential malignancy of the tumor.
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