INTRODUCTION AND OBJECTIVES: We investigated the prognostic significance of the various manifestations of extrarenal extension which comprise pathologic stage T3a renal cell carcinoma (RCC) among patients treated with extirpative therapy for nonmetastatic disease.METHODS: A retrospective review of 595 patients who underwent nephrectomy for pathologically-confirmed T3aN0/NxM0 clear cell RCC between 1970 and 2011 was performed. All pathologic slides were re-reviewed by a single urologic pathologist. Associations of the type of extrarenal extension (perinephric fat, renal sinus fat, and renal vein in isolation or in any combination) with disease progression, death from RCC, and death from any cause were evaluated using Cox models adjusting for demographic and pathologic features.RESULTS: Overall, perinephric fat invasion, renal sinus fat invasion, renal vein tumor thrombus, and multiple sources of extrarenal extension were present in 160 (27%), 59 (10%), 167 (28%), and 209 (35%) patients, respectively. Median follow-up after surgery was 9.1 years (IQR 6.7, 13.2), during which time 343 patients developed disease progression at a median of 1.5 years (IQR 0.5-4.3), 271 patients died from RCC at a median of 3.5 years (IQR 1.6-7.3), and 463 patients died from any cause at a median of 4.9 years (IQR 2.0-10.0) following surgery. No significant differences in the rates of disease progression, death from RCC, or death from any cause were observed in the presence of isolated perinephric fat invasion, renal sinus fat invasion, or renal vein tumor thrombus. However, on multivariable analyses, patients with multiple sources of extrarenal extension were at a significantly increased risk of disease progression (HR 1.31, 95%CI¼1.05-1.64, P¼0.017), death from RCC (HR 1.64, 95%CI¼1.28-2.11, P<0.001), and death from any cause (HR 1.31, 95%CI¼1.08-1.60, P¼0.007) compared to patients with an isolated source of extrarenal extension.CONCLUSIONS: Isolated involvement of the perinephric fat, renal sinus fat, or renal vein carry similar prognostic weight, justifying grouped classification as T3a in the contemporary AJCC primary tumor classification. However, presence of multiple sources of extrarenal extension is associated with higher risk for disease progression, cancerrelated death, and death from any cause after nephrectomy. If validated, these findings may help refine risk-stratification of non-metastatic T3a RCC.

<b><i>Introduction:</i></b> The objective of this study was to present our clinical experience of using the thulium fiber laser in retrograde intrarenal surgery (RIRS). <b><i>Methods:</i></b> A prospective clinical study performed after the IRB approval (Sechenov University, Russia). Patients with stones &#x3c;30 mm were treated with SuperPulsed thulium fiber laser (SP TFL) (NTO IRE-Polus, Russia) through a 200-μm-diameter fiber. Stone size, density, the duration of the operation, and laser on time (LOT) were measured. Based on the surgeon’s feedback, retropulsion and intraoperative visibility were also assessed (Likert scale). Stone-free rates (SFRs) were assessed with a low-dose CT scan 90 days after the operation. <b><i>Results:</i></b> Between January 2018 and December 2019, 153 patients (mean age 54 ± 2.8 years) underwent RIRS with SP TFL (mean stone density 1,020 ± 382 HU). Median stone volume was 279.6 (139.4–615.8) mm³. Median LOT was 2.8 (IQR 1.6–6.6) min with median total energy for stone ablation 4.0 (IQR 2.1–7.17) kJ, median ablation speed was 1.7 (1.0–2.8) mm³/s, median ablation efficacy was 13.3 (7.3–20.9) J/mm³, and energy consumption was 170.3 (59.7–743.3) J/s. Overall, the SFR (at 3 months) was 89%. The overall complication rate was 8.4%. Retropulsion was present in 23 (15.1%) patients. Visibility was estimated as optimal in most patients, with poor visibility reported in only 13 (8.5%) patients. <b><i>Conclusion:</i></b> The SP TFL is a safe and efficient tool in lithotripsy, irrespective of the stone type and density. Retropulsion is minimal and visibility is maintained with SP TFL. Nonetheless, further clinical studies are needed to ensure optimal comparison with conventional holmium:YAG lithotripsy.

Background: Approximately 80% of patients with indwelling ureteral stents experience stent related symptoms (SRS). We believe SRS can be reduced through altering the composition of ureteral stents to a less firm material. Therefore, we aim to compare modern silicone and polyurethane ureteral stents in terms of SRS intensity and safety. Methods: From June 2018 to October 2018, patients from two distinct clinical centers were prospectively enrolled in the study and stratified (non-randomly) into either control group A, patients who received polyurethane stents (Rüsch, Teleflex), or experimental group B, patients who received silicone stents (Cook Medical). Each participant completed a survey 1 h after stent insertion, in the middle of the stent dwelling period, and before stent removal or ureteroscopy noting body pain and overactive bladder via the visual analog scale pain (VASP) and overactive bladder (OAB) awareness tool, respectively. Additionally, successfulness of stent placement, hematuria, number of unplanned visits, and stent encrustation rates were assessed within each group. Results: A total of 50 patients participated in the study, control group A consisted of 20 patients and experimental group B consisted of 30 patients. Participants in group B, silicone ureteral stents, demonstrated significantly lower mean values of VASP 2 weeks prior to stent removal and promptly before stent removal (p = 0.023 and p = 0.014, respectively). No other comparisons between the two groups were statistically significant. Conclusions: Compared to polyurethane ureteral stents, silicone ureteral stents are associated with lower body pain intensity assessed by VASP 2 weeks before stent removal and at the time of stent removal. Trial registration: Current Controlled Trials NCT04000178. Retrospectively registered on June 26, 2019.

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INTRODUCTION AND OBJECTIVES: The Moses Technology developed to enhance the High power Holmium lasers (HPH) lithotripsy is challenged by the novel Super-pulse Thulium fibre laser. The goal of our study was to evaluate in-vitro which laser has a better stone ablation effect.METHODS: An in-vitro observational study was performed using a Super-Pulse Thulium fiber (SPT) laser prototype with 200 µm fibre and a High-Power Holmium (HPH) laser Moses Technology (Lumenis Pulse 120H) with 230 µm fibre. A mechanical device for precisely holding the laser fibre was created (Fig. 1). Fine metal sheets calibrated at different widths were used to fix the laser fibre at the required distance from the tissue. The laser was activated for ten seconds using different laser settings and at different distances from the target (0 mm, 1 mm, 2 mm), in saline.Calcium oxalate monohydrate (COM) -like artificial stones were created in a standardised manner. The ablation volumes were precisely measured using a 3D high precision computer controlled optical microscanner. The obtained images were processed using two Autodesk softwares.RESULTS: On the stone phantoms, the laser ablation volume increased with the laser power and decreased with the distance to target.Moses technology in distance mode provided bigger ablation volumes than close mode, especially at 1 mm distance from the stone, at the same laser settings The difference was not statistically significant. SPT ablation volume was similar to HPH Moses distance mode when same power and energy were used. SPT ablation volume was similar to HPH Moses close mode when same power but very low energy and very high frequency were used.Ablation volume for each machine's best capabilities for dusting settings (HPH 0.2J/80Hz, SPT 0.05J/900 Hz) was almost three times better for SPT. (Table 1) CONCLUSIONS: At same power, HPH Moses and SPT have similar effect on stones.The big difference is when maximal dusting setting are used, SPT being more efficient than HPH Moses.