The supracostal approach was found to be effective as well as safe, with acceptable complications. It gives high stone clearance rates with acceptable morbidity rates and should be attempted in selected cases. The rate of pulmonary complications is higher with the supracostal approach. If the supracostal approach is indicated, it should be used with caution.
Minimizing X-ray exposure during percutaneous nephrolithotomy (PCNL) is challenging. Using the single semirigid dilator, also called "one-shot" or "one-stage" is a good alternative to routine telescopic metal dilators to reduce X-ray exposure. Our aim was to compare the single semirigid one-shot dilator with a telescopic metal dilator in PCNL. The intraoperative status was evaluated in 100 consecutive patients randomly assigned to two equal groups undergoing PCNL either with the one-shot (group A) or telescopic technique (group B). No significant difference in stone burden and location existed between the groups (P > 0.05). The mean age of group A and group B was 44.8 ± 15 and 45.6 ± 14 years, respectively (P = 0.78). The mean operation time was 51.14 ± 40.85 min in group A and 57.00 ± 38.85 min in group B (P = 0.46). The mean X-ray exposure time was 41.2 ± 17 and 48.4 ± 15 s in group A and group B, respectively (P = 0.03). The stone-free rate was 94 % (n = 47) in group A and 84 % (n = 42) in group B (P = 0.10). The mean hemoglobin drop was 1.26 ± 0.09 and 1.44 ± 0.11 g/dl in group A and group B, respectively (P = 0.09). The one-shot technique is feasible, safe, and well tolerated in patients undergoing PCNL. In addition to lack of complications, the method also provides less radiation exposure for urologists and nursing teams.
Changes in the cellular microenvironment play a critical role in the development of bladder cancer (BC). Yes‐associated protein (YAP), a central mediator of the Hippo pathway, functions as a nuclear sensor of mechanotransduction that can be induced by stiffness of the extracellular matrix (ECM), including stiffness resulting from surgical manipulations. We aimed to clarify the possible association between surgically‐related ECM stiffness and YAP activation in BC patients. We compared 30 bladder cancer tissues with grade II (n = 15 recurrent and n = 15 newly diagnosed) with 30 adjacent healthy tissues. Atomic force microscopy showed that patients with recurrent BC had stiffer ECM than newly diagnosed patients (P < 0.05). Gene expression profiles showed that β1 integrin (ITGB1), focal adhesion kinase (FAK), CDC42, and YAP were upregulated in cancerous tissues (P < 0.05); additionally, β1 integrin activation was confirmed using a specific antibody. Nuclear localization of YAP was higher in recurrent cancerous tissues compared with newly diagnosed and it was positively associated with higher stiffness (P < 0.05). Our results suggest that postsurgery‐induced ECM stiffness can influence integrin–FAK–YAP activity and thereby YAP trafficking to the nucleus where it contributes to BC progression and relapse.
In the short term it seems that transureteral and shock wave lithotripsy are acceptable modalities for the treatment of distal ureteral calculi in children. However, transureteral lithotripsy has a higher efficacy rate when performed meticulously by experienced hands using appropriate instruments.
PurposeThe fifth most common cancer is allocated to bladder cancer (BC) worldwide. Understanding the molecular mechanisms of BC invasion and metastasis to identify target therapeutic strategies will improve disease survival. So the aim of this study was to measure expression rate of zinc finger E-box binding homeobox 1 (ZEB1) and transforming growth factor-beta2 (TGF-β2) mRNA in tissue samples of patients with BC and its healthy adjacent tissue samples and their association with muscle invasion, size and grade of the tumor.Materials and MethodsTissue samples were collected from 35 newly diagnosed untreated patients with BC from 2013 to 2014. Total RNA was extracted from about 50-mg tissue samples using TRIzol reagent. TAKARA SYBR Premix EX Tag II was applied to determine the rate of mRNA expression by real-time polymerase chain reaction (PCR). To obtain final validation, PCR product of ZEB1 and TGF-β2 were sequenced. STATA 11 software was used to analyze the data.ResultsThe expression level of ZEB1 in tumor samples was significantly more than of in healthy adjacent tissue samples. Up-regulation of TGF-β2 showed a strong association with muscle invasion (p=0.017). There was also demonstrated a relationship between over expression of ZEB1 with the tumor size (p=0.050).ConclusionsIt looks ZEB1 and TGF-β2 had a role in BC patients. In this study ZEB1 expression was higher in BC tissues than that of in healthy control tissues. There was demonstrated a markedly association between overexpression of TGF-β2 and muscle invasion. Therefore, they are supposed to be candidate as potential biomarkers for early detection and progression of BC.
There are various approaches for the percutaneous nephrolithotomy (PCNL). Supracostal approach is a well known technique for doing of it. This approach is being done commonly under general anesthesia (GA). In this retrospective study, we evaluated the feasibility of supracostal PCNL under regional anesthesia (RA) and compared it with the same procedure under GA. Since March 2000 to March 2005, a total of 123 renal stone cases underwent PCNL with supracostal access in our center. GA was selected in 69 cases (56 %) (Group 1), spinal anesthesia (SA) in 45 cases (36.5 %), and epidural anesthesia (EA) in 9 cases (7.5 %) (Group 2). The operative time, success rate, hospital stay, and ensuing complications were compared between group 1 and group 2. There were no significant differences between groups 1 and 2 among surgical parameters, including age, stone area, anesthesia time, and hospitalization time (P > 0.05). There was no difference in the rate of complications or success rate between GA and RA cases (P > 0.05). Overall complete stone free rate, regardless of stone size, in relation to type of anesthesia was as follows: 88.4 % for GA, 88.9 % for EA, and 91.1 % for SA (P > 0.05). Conversion to GA was not needed in any patient with RA. The results showed that the supracostal PCNL with regional anesthesia was feasible but without evident advantages versus general anesthesia in this population, and possible advantages of the procedure in patients with pulmonary co-morbidities have still to be evaluated. The anesthesia related complications of RA were negligible and easily controllable.
Pheochromocytomas are catecholamine producing tumors of adrenal gland generally diagnosed by presence of these markers in urine or plasma. However, a few may be marker-negative and challenging for clinicians. Several reports of these marker-negative pheochromocytomas may warrant necessity for a new classification of these tumors. Adrenergic blockade before surgery is one of the main reasons for recognition of these cases. We present a case of marker-negative pheochromocytoma which turned out to be malignant on its recurrence. To our knowledge, this is the only case of malignant marker-negative pheochromocytoma reported in literature so far.
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