This study suggests that fragment size larger than 4 mm after ureteroscopy is associated with significantly higher rates of stone growth, complications and the need for re-intervention. Ensuring complete stone-free status is the most effective strategy to reduce stone events after ureteroscopy.

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Purpose: To investigate the safety of microwave ablation (MWA) as an emerging technology for treating small renal masses. Materials and Methods: Patients with renal masses treated at a high-volume center with MWA between March 2015 and June 2019 were retrospectively identified. Safety, changes in renal function, primary treatment efficacy, and the natural history of imaging characteristics of masses postablation were examined. Results: Forty-five patients underwent MWA during the study period. Median age was 71 years (range 31-87). Median RENAL nephrometry score was 6 (range 4-9) with mean tumor size 2.6 -0.7 cm. Thirty-three percent of tumors were within 4 mm of the collecting system. Median total microwave energy applied was 400 W (range 105-2600 W). There was no significant change in creatinine ( p = 0.21) or glomerular filtration rate (GFR) ( p = 0.09) from preoperative to postoperative day 1 (POD#1) levels. There was a statistically but not clinically significant decrease in hemoglobin from preoperative to POD#1 levels (estimated -0.06 from 7 days before procedure to POD#1, p = 0.02). There was no durable change in creatinine ( p = 0.16) or GFR ( p = 0.72) at median follow-up of 7.5 months. There were 4 (9%) complications: three Clavien grade 1 and one Clavien grade 3 that led to loss of the kidney. Tumor size decreased postoperatively by an estimated -0.03 cm/month (range 0-1.9 cm, p < 0.01). Initial technical success was 100%. Primary treatment efficacy was 94%. Conclusion: MWA shows promise as an alternative thermal ablative technique with excellent short-term outcomes.

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Here we have improved an existing mouse model of prostate cancer based on prostate-specific deletion of Pten and Trp53 by incorporating a Cre-activatable luciferase reporter. By coupling the deletion of those genes to the activation of a luciferase reporter, we were able to monitor tumor burden non-invasively over time. We show that, consistent with previous reports, deletion of both Pten and Trp53 on a C57BL/6 background accelerates tumor growth and results in both the loss of androgen receptor expression and castrate resistant tumors as compared with loss of Pten alone. Loss of Trp53 results in the development of sarcomatoid histology and the expression of markers of epithelial-to-mesenchymal transition Zeb1 and vimentin, with kinetics and penetrance dependent on whether one or both alleles of Trp53 were deleted. Homozygous deletion of Trp53 and Pten resulted in uniformly lethal disease by 25 weeks. While we were able to detect locally invasive disease in the peritoneal cavity in aggressive tumors from the double knockout mice, we were unable to detect lymphatic or hematogenous metastatic disease in lymph nodes or at distant sites.

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Introduction: We performed a decision analysis model of the cost-effectiveness of observation vs intervention for asymptomatic residual fragments less than 4 mm in diameter following ureteroscopic holmium laser lithotripsy.Methods: Outcomes data from a retrospective analysis evaluating the natural history, complications and reintervention rates of asymptomatic residual stone fragments performed by the EDGE (Endourology Disease Group for Excellence) Research Consortium were used. A decision analysis model was constructed to compare the cost-effectiveness of initial observation of residual fragments to immediate intervention. Cost of observation included emergency room visits, hospitalizations and reinterventions. The cost analysis model extended to 3 years to account for delayed reintervention rates for fragments less than 4 mm. Costs of emergency department visits, readmissions and reinterventions were calculated based on published figures from the literature.Results: Decision analysis modeling demonstrated that when comparing initial observation to immediate reintervention, the cost was $2,183 vs $4,424. The difference in cost was largely driven by the fact that over 3 years, approximately 55% of all patients remained asymptomatic and did not