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Objectives To determine the eBcacy and costs of extraureter in 24 patients and in the lower ureter in 80. The outcome was assessed by stone-free rates, corporeal shock-wave lithotripsy (ESWL) compared with ureteroscopy (URS) in the treatment of mid-and re-treatment rates, time to become stone-free, complications and costs. lower ureteric calculi. Patients and methods The records of patients treatedResults ESWL for mid-and lower ureteric calculi resulted in a success rate of 90% and 81%, respectively, primarily by ESWL and URS were analysed retrospectively. Treatment with ESWL included 63 patients (42 compared with 96% and 99% for URS. However, patients treated with URS were stone-free within men and 21 women, mean age 52 years, range 23-78, 19 mid-and 44 lower ureteric calculi). All 2 days, whereas patients in the ESWL group required up to 4 months. The best results for ESWL were patients received 4000 shock waves at a mean energy setting of 18.1 kV. URS was used in 105 patients, achieved with stones of <50 mm2. The costs of URS were higher than those for ESWL. with a 7.2 F miniscope or the 7.1 F flexible scope. Stones were fragmented with a pulsed-dye laser lithoConclusions ESWL provides a noninvasive, simple and safe option for the management of mid-and lower tripter at 504 nm and a power of up to 130 mJ (mean 53 mJ) using a 200 or 320 mm fibre. All ureteroscopies ureteric calculi, provided that the stones are <50 mm2; larger stones are best treated by URS. were performed with the patient under general (n= 17) or spinal (n=87) anaesthesia in a mean treatment Keywords Ureteric calculi, extracorporeal shock-wave lithotripsy, ureteroscopy duration of 34 min. Stones were located in the mid-URS, and controversy about the optimal treatment

Aims-Investigation of the histopathological changes in prostatectomy specimens of patients with prostate cancer after high intensity focused ultrasound (HIFU) and identification of immunohistochemical markers for tissue damage after HIFU treatment. Methods-Nine patients diagnosed with adenocarcinoma of the prostate underwent unilateral HIFU treatment seven to 12 days before radical prostatectomy. The prostatectomy specimens were analysed histologically.Immunohistochemical staining and electron microscopy were performed to characterise more subtle phenotypic changes. Results-All prostatectomy specimens revealed well circumscribed HIFU lesions at the dorsal side of the prostate lobe treated. Most epithelial glands in the centre of the HIFU lesions revealed signs of necrosis. Glands without apparently necrotic features were also situated in the HIFU lesions, raising the question of whether lethal destruction had occurred. This epithelium reacted with antibodies to pancytokeratin, prostate specific antigen (PSA), and Ki67, but did not express cytokeratin 8, which is indicative of severe cellular damage. Ultrastructural examination revealed disintegration of cellular membranes and cytoplasmic organelles consistent with cell necrosis. HIFU treatment was incomplete at the ventral, lateral, and dorsal sides of the prostate lobe treated. Conclusions-HIFU treatment induces a spectrum of morphological changes ranging from apparent light microscopic necrosis to more subtle ultrastructural cell damage. All HIFU lesions are marked by loss of cytokeratin 8. HIFU does not aVect the whole area treated, leaving vital tissue at the ventral, lateral, and dorsal sides of the prostate.

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We observed that patients treated in clinical trials differed from patients who were not. We concluded that this may lead to differential treatment and survival. Caution is warranted when real-world outcomes are compared with trial results.