Cite as: Can Urol Assoc J 2014;8(1-2):e8-11. http://dx.doi.org/10.5489/cuaj.1261 Published online January 14, 2014.
AbstractIntroduction: We evaluate the efficiency of α-adrenergic antagonists on stone clearance after extracorporeal shock wave lithotripsy (ESWL) in patients with lower ureteral stones. Methods: A total of 356 patients with solitary lower ureteral stones who underwent single ESWL sessions were divided into 2 groups. Group 1 received our standard medical therapy, and Group 2 was treated with 0.4 mg/day tamsulosin for a maximum of 2 weeks. All patients were re-evaluated with plain film radiography and ultrasound each week during the treatment period. A computed tomography scan was systematically performed 3 months after ESWL. Results: In total, 82 of the 170 patients in Group 1 (48.2%) and 144 of the 186 patients in Group 2 (77.4%) (p = 0.002) were stonefree. Among the patients with stones 10 to 15 mm in diameter, the stone-free rate was 38.4% in Group 1 and 77.1% in Group 2 (p = 0.003). Average stone expulsion time was 10.6 days and 8.4 days in Groups 1 and 2, respectively. Ureteral colic occurred in 40 patients (23.5%) in Group 1, but only in 10 patients (5.3%) in Group 2 (p = 0.043). The only side effect of tamsulosin was slight dizziness in 5 of the 186 patients in Group 2 (2.6%). Conclusion: Adjunctive therapy with α1-adrenergic antagonists after ESWL is more efficient than, and equally as safe as, lithotripsy alone to manage patients with lower ureteral stones. The adding of α-blockers is more reliable and helpful for stones with a large dimension, and can also decrease stone elimination time and episodes of ureteral colic.
Objective:Gleason scores, as determined by 18-gauge core needle biopsies (NB), were compared with both Gleason scores and the pathological staging of corresponding radical prostatectomy( RP) specimens. The goal was to evaluate the clinical implication and the prognostic impact of these discrepancies. Methods: Records of 234 consecutive patients undergoing a radical retro pubic prostatectomy between 2001 and 2012 were reviewed. In total, all our patients were enrolled, al1 of whom had been diagnosed with adenocarcinoma by transrectal needle biopsies using an 18-gauge automated spring-loaded biopsy gun. Results: Grading errors were greatest with wel1-differentiated tumors. The accuracy was 18 (23%) for Gleason scores of 2-4 on needle biopsy. Of the 108 evaluable patients with Gleason scores of 5-7 on needle biopsy, 84 (78%) were graded correctly. All of the Gleason scores of 8-10 on needle biopsy were graded correctly. 54 of 162 patients (33%), with a biopsy Gleason score of < 7 had their cancer upgraded to above 7. Tumors in 18 patients (60%) with both a Gleason score < 7 on the needle biopsy and a Gleason score of 7 for the prostatectomy specimen were confined to the prostate. Conclusion: The potential for grading errors is greatest with well-differentiated tumors and in patients with a Gleason score of < 7 on the needle biopsy. Predictions using Gleason scores are sufficiently accurate to warrant its use with all needle biopsies, recognizing that the potential for grading errors is greatest with well-differentiated tumors.
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