Study Type – Practice patterns (retrospective cohort) Level of Evidence 2b OBJECTIVE • To evaluate the safety and feasibility of laparoscopic adrenalectomy (LA) performed in several German centres with different laparoscopic experience, as LA has become the gold‐standard approach for benign surgical adrenal disorders; however, for solitary metastasis or primary adrenal cancer its precise role is uncertain. PATIENTS AND METHODS • The data of 363 patients who underwent a LA were prospectively collected in 23 centres. • All centres were stratified into three groups according to their experience: group A (<10 LAs/year), group B (10–20 LAs/year) and group C (>20 LAs/year). • In all, 15 centres used a transperitoneal approach, four a retroperitoneal approach and four both approaches. • Demographic data, perioperative and postoperative variables, including operating time, surgical approach, tumour size, estimated blood loss, complications, hospital stay and histological tumour staging, were collected and analysed. RESULTS • The transperitoneal approach was used in 281 cases (77.4%) and the retroperitoneal approach was used in 82 patients (22.6%). • In all, 263 of 363 lesions (72.5%) were benign and 100 (27.5%) were malignant. • The mean (sd) operating time was 127.22 (55.56) min and 130.16 (49.88) min after transperitoneal and retroperitoneal LA, respectively. • The mean complication rates for transperitoneal and retroperitoneal LA were 5% and 10.9%, respectively. CONCLUSION • LAs performed by urologists experienced in laparoscopy is safe for the removal of benign and malignant adrenal masses. LA for malignant adrenal tumours should be performed only in high‐volume centres by a surgeon performing at least >10 LAs/year.

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Since August 1985 extracorporeal shock wave lithotripsy has been performed in 39 patients with prevesical ureteral stones, including 3 with steinstrasse after extracorporeal shock wave lithotripsy of kidney stones. Female patients less than 40 years old were excluded because of the theoretical possibility of harm to the ovary by shock waves. Via a modified technique with the patient in a flat position, x-rays and shock waves enter through the foramen obturatum. High total power (high number of shocks and high kilovoltage) led to complete stone disintegration and a success rate of 95 per cent was achieved. While ureterorenoscopy should be more restricted, extracorporeal shock wave lithotripsy is the method of choice for the treatment of distal ureteral stones.

Nine cases with histologically proven renal oncocytoma are presented. In all cases, ultrasonography gave the first indication of a tumour and intravenous urography was tumour-specific in only six, whilst angiography was so in only four of the cases with peripheral extension beyond the normal organ limits. Examination by computed tomography showed retrospectively, in the three cases with smaller oncocytomas up to 3 cm in diameter, findings that seemed promisingly characteristic: without contrast medium, the tumour appeared homogeneously hyperdense in comparison with normal renal parenchyma, but homogeneously hypodense after injection of contrast medium. One of the smaller oncocytomas, however, showed regions of heterogeneity both with and without contrast medium. Only one oncocytoma of 4 cm diameter presented the central stellate, low-attenuation "scar" described by Quinn et al. The angiographic criteria cited by Ambos were fulfilled in only three of the larger oncocytomas. In four of the cases, the tumour was enucleated and the organ left in situ on the basis of frozen section diagnosis. Those patients with tumours extending outside the organ or those of questionable diagnosis on frozen section were treated by nephrectomy. In one patient, the pathologist suspected metastasis from the thyroid; hemithyroidectomy confirmed on oncocytic adenoma of the left thyroid lobe.

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