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The Alken dilation technique produces similar results to the Amplatz dilators in terms of efficiency, safety, and total operative time. Notwithstanding, it is more cost-effective in comparison.

Purpose. To compare the effectiveness and safety of retroperitoneal laparoscopic ureterolithotomy (RLU) and percutaneous antegrade ureteroscopy (PAU) in which we use semirigid ureteroscopy in the treatment of proximal ureteral stones. Methods. Fifty-eight patients with large, impacted stones who had a history of failed shock wave lithotripsy (SWL) and, retrograde ureterorenoscopy (URS) were included in the study between April 2007 and April 2014. Thirty-seven PAU and twenty-one RLU procedures were applied. Stone-free rates, operation times, duration of hospital stay, and follow-up duration were analyzed. Results. Overall stone-free rate was 100% for both groups. There was no significant difference between both groups with respect to postoperative duration of hospital stay and urinary leakage of more than 2 days. PAU group had a greater amount of blood loss (mean hemoglobin drops for PAU group and RLU group were 1.6 ± 1.1 g/dL versus 0.5 ± 0.3 g/dL, resp.; P = 0.022). RLU group had longer operation time (for PAU group and RLU group 80.1 ± 44.6 min versus 102.1 ± 45.5 min, resp.; P = 0.039). Conclusions. Both PAU and RLU appear to be comparable in the treatment of proximal ureteral stones when the history is notable for a failed retrograde approach or SWL. The decision should be based on surgical expertise and availability of surgical equipment.

The aim of the present study was to determine how the modified Gleason grading (mGG) system affects the score discrepancy between needle biopsy (NB) and radical prostatectomy (RP) and to investigate the effect of the modified scores on nomogram predictions. When the conventional Gleason grading (cGG) and mGG systems were compared, a new Gleason score was obtained in the NBs for 40 out of 97 patients (41.2%; P < .001) and in the RP specimens for 15 out of 97 patients (15.5%; P = .005). The agreement between the NBs and RP specimens rose from 31.9% to 44.3% with the mGG system (P = .017). However, when the predictions calculated with the location of modified Gleason scores in the Memorial Sloan Kettering Cancer Center nomogram were compared with those of the conventional Gleason scores, higher pathological stage and lower life expectancy predictions were obtained. Therefore, when a clinician is making a choice from therapeutic options, this change should be taken into account.

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