The objective of this study was to retrospectively analyze the clinical outcomes of ureteroscopic lithotripsy (USL) performed in patients with ureteral stones, and to investigate the factors associated with therapeutic outcomes. This study included a total of 2,129 patients with ureteral stones who underwent USL between December 1985 and March 2006 in a single institution in Japan. In this series, ultrasonic lithotripsy was primarily performed, and forceps and/or baskets were occasionally used for the removal of stones. Complete removal was defined as total clearance 1 day after the initial USL. The initial stone-free rate following a single treatment with USL was 73.3%. Of 569 patients diagnosed as having fragmentation of residual stones, additional therapy was not performed for 115 with stones likely to pass spontaneously, while the remaining 454 subsequently underwent extracorporeal shock wave lithotripsy. Thereafter, ureterolithotomy or percutaneous nephrolithotripsy was further added in 14. Ureteral perforation occurred in 14 patients, of whom 2 underwent nephrectomy; however, there were no other serious complications that could not be managed by conservative treatment. Whether ureteral stones were completely removed by an initial USL was significantly associated with the history of ureteral stone, severity of clinical symptoms, number of stones, localization of stones and maximal diameter of stones. Furthermore, multivariate analysis identified the severity of clinical symptoms, number of stones, localization of stones and maximal diameter of stones as independent predictors for complete removal of ureteral stones by the initial USL application. These findings suggest that USL could be a safe and effective treatment option for ureteral stones; however, other therapeutic strategies should also be considered in patients with currently identified risk factors associated with treatment failure following a single USL procedure.
In general, patients undergoing lithotripsy for urinary stones may have a comparatively favorable HRQoL; however, BP and GH were impaired in patients undergoing lithotripsy twice or more and those treated by invasive modalities, respectively. Considering these findings, it would be important to prevent recurrent stone formation and to develop less invasive procedures to further improve HRQoL in patients undergoing lithotripsy for urinary stones.
These findings indicate that hemodialysis patients may have an increased risk of prostate cancer, and that prostate cancer detected in such patients tends to be relatively advanced. Therefore, it would be recommended for hemodialysis patients to undergo PSA testing to screen for prostate cancer.
These findings suggest that the clinical characteristics of CU and NCU clearly differ and that CU tends to require a longer time to cure than NCU; therefore, among patients with non-gonococcal urethritis, it would be particularly important to effectively control the spread of CU.
Five patients with penile cancer were treated with radical radiotherapy combined with concurrent THP-ADM. No patient demonstrated distant metastasis, but three patients had regional nodes metastasis at first presentation. Delivered dose was 60 Gy over 8-weeks and 10 mg/m2 of THP-ADM was administered once a week during irradiation. Three of the five cases (60%) achieved complete response. Regarding the primary tumor complete response was noted in three cases (60%) and partial response in two (40%). Regarding the lymph nodes complete response was observed in two cases (67%) and no change in one. Histological effect upon the primary tumor was Grade IV in three cases and Grade IIB in two according to Obosi-Shimosato's criteria. That of the metastatic lymph nodes was Grade IV in one case. Three patients (60%) were alive with no evidence of disease with a median follow up of 27 months. Leukocytopenia and erosion of the penile skin were observed in all cases and meatal stenosis in one. All of these toxicities were acceptable. These results suggested that this combined therapy is effective for penile cancer and useful for the penis preserving treatment.
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