Stavros Sfoungaristos

External Validation of CROES Nephrolithometry as a Preoperative Predictive System for Percutaneous Nephrolithotomy Outcomes.

PURPOSEnWe externally validated CROES (Clinical Research Office of the Endourological Society) nephrolithometry and evaluated the predictive accuracy of the nomogram.nnnMATERIALS AND METHODSnData were collected on patients who underwent percutaneous nephrolithotomy between January 2012 and February 2015. The CROES nomogram was applied to all patients and externally validated. The AUC and calibration plot were used for discrimination and clinical validity assessment.nnnRESULTSnA total of 176 patients were included in study. Mean ± SD patient age was 55.2 ± 13.9 years and the mean stone burden was 640.0 ± 911.4 mm(2). The CROES nomogram was significantly associated with stone number, location and burden, and the number of implicated calyces, punctures and tracts. The postoperative treatment success rate was 85.8%. The number of stones, number of implicated calyces and CROES score were independent predictors of treatment success. The estimated AUC was 0.715 and the model provided good calibration.nnnCONCLUSIONSnThe CROES nomogram is an accurate tool to estimate renal stone complexity. CROES nephrolithometry provides great accuracy to predict postoperative efficacy.

Solitary fibrous tumor of the kidney with massive retroperitoneal recurrence. A case presentation.

Solitary fibrous tumor is an unusual spindle cell neoplasm that usually occurs in the pleura but has also been described in other sites. Renal presentation is rare and only 38 cases of SFT of the kidney have been described until now. Up to 90% of the tumors have benign characteristics. Local retroperitoneal recurrence is extremely rare. We report a case of a large malignant solitary fibrous tumor recurrence after the surgical excision of the primary tumor. Histological examination of the specimen confirmed the diagnosis by revealing highly positive reaction of the neoplasmatic cells for vimentin, CD34, bcl-2 and moderately positive for actin. The rate of Ki67 lied between 2-7%. No adjuvant therapy was given to the patient and he is disease-free with no imaging findings of recurrence or metastasis 9 months after the re-operation.

Percutaneous nephrolithotomy for staghorn stones: Which nomogram can better predict postoperative outcomes?

AbstractPurposenTo identify independent predictors for postoperative stone-free status after percutaneous nephrolithotomy (PCNL) for staghorn stones and to compare Guy’s, CROES and STONE nomograms regarding their predictive ability and accuracy specifically for staghorn stones.MethodsData of 286 patients who underwent PCNL in our department were collected and analyzed. Several parameters, including the three nomograms, were analyzed to reveal independent predictors for postoperative stone-free status. The area under the curve was used to assess the predictive ability of the independent predictors.ResultsA total of 73 staghorn calculi were identified with mean stone burden of 1253.5xa0mm2. Mean Guy’s, CROES and STONE score was 3.34, 125.8 and 9.95, respectively. Postoperative stone-free rate was 65.8xa0%. In univariate analysis, all three nomograms were significantly associated with stone-free status. However, STONE was the only significant independent predictor in multivariate analysis. STONE also revealed the highest predictive accuracy compared to Guy’s and CROES nomogram.ConclusionsSTONE nephrolithometry was found to be the only predictor for stone-free rate after PCNL for staghorn stones compared to Guy’s and CROES nomograms.

Surgical experience gained during an endourology fellowship program may affect fluoroscopy time during ureterorenoscopy

The purpose of this study was to identify parameters that affect fluoroscopy time during ureteroscopy or retrograde intrarenal surgery (RIRS) and to evaluate the potential role of surgical experience gained during a fellowship program in decreasing radiation exposure. A database of patients who underwent ureteroscopy or RIRS was evaluated. Procedures were performed either by an experienced Endourologist (surgeon A) or by an Endourology fellow. Operations performed by the fellow were further divided to them performed during fellow’s 1st year of training (surgeon F1) and 2nd year of training (surgeon F2). The association between fluoroscopy time and several factors was evaluated. Eighteen (19.6xa0%) procedures were performed by surgeon F1, 13 (14.1xa0%) by surgeon F2 and 61 (66.3xa0%) cases were performed by surgeon A. Fluoroscopy time was significantly higher in cases performed by surgeon F1 compared to surgeon F2 (pxa0=xa00.025) and A (pxa0=xa00.001). However, there was no difference between surgeon F2 and A (pxa0=xa00.969). There was significant association between fluoroscopy time and obesity (pxa0=xa00.023), stone size (pxa0=xa00.009), surgical experience (pxa0=xa00.001), procedure duration (pxa0<xa00.001) and the insertion of a postoperative double-J stent (pxa0<xa00.001). Multivariate analysis showed that procedure duration (pxa0=xa00.003), postoperative stenting (pxa0=xa00.009) and surgeon’s experience (pxa0<xa00.001) were all significant independent predictors of increased fluoroscopy time. Fluoroscopy time may widely vary during ureteroscopy and RIRS. Procedure duration, the insertion of a postoperative double-J stent and surgical experience are all independent predictors of increased fluoroscopy time.

PSA density versus risk stratification for lymphadenectomy-making decision in patients with prostate cancer undergoing radical prostatectomy

ObjectivesTo determine the value of PSA density as independent predictor for lymph node invasion in order to decide lymphadenectomy in patients undergoing radical prostatectomy.Patients and methodsWe retrospectively analyzed the medical records of 179 patients who undergone radical prostatectomy from January 2001 until September 2010. Studied patients divided in groups regarding the preoperative risk for lymph node metastasis (low risk or not) and PSA density (≤.2 or greater). Age, prostate volume, preoperative PSA, and preoperative Gleason score (≤6 or ≥7) were estimated as well. We analyze the impact of the above factors in prediction of lymph nodes metastasis after radical prostatectomy.ResultsOne patient found to have lymph node invasion out of 48 who stratified as low-risk patients and 1 out of 77 who had PSA density ≤.2. There was a significant correlation between preoperative PSA, PSA density, and risk stratification among patients who had metastasis or not. These findings confirmed in the univariate analysis of these factors. However, in multivariate analysis, PSA density was the only statistically significant predictor.ConclusionThis is the first study to compare preoperative risk stratification and PSA density as predictors of lymph node metastasis in patients who are planned for radical prostatectomy. PSA density values ≤.2 can predict lymph nodes metastasis in a larger population of patients and consequently can potentially decrease the number of lymphadenectomies during radical prostatectomy procedures.

Present and future therapeutic options for locally advanced and metastatic renal cell carcinoma

Introduction: Locally advanced or metastatic renal cell carcinoma (RCC) is notoriously chemo- and radioresistant, leaving immunotherapy as the only treatment option. In recent years, targeted therapies have offered significant increases in progression-free survival (PFS). Despite this, the majority of patients soon develops resistant disease and finally succumbs. The need to implement treatment strategies that improve overall survival while having an acceptable safety profile is imperative. Areas covered: This review provides information on the efficacy of recently studied treatment strategies for advanced RCC. These include sequential and combination therapy of established drugs as well as data on agents in early clinical development. The Medline and ASCO database were searched for clinical trials on medical therapy of advanced RCC from 2004 until May 2010. Data on targeted therapies, including tyrosine kinase inhibitors, vascular endothelial growth factor inhibitors, mammalian target of rapamycin inhibitors, and antiepidermal growth factor receptor agents are summarized. Expert opinion: Improvements in response rates and PFS in patients with advanced RCC have been observed with new treatment strategies. The benefit in overall survival is less clear and needs further evaluation. Toxicity represents a concern especially in combination regiments.

Prevention of renal stone disease recurrence. A systematic review of contemporary pharmaceutical options

Introduction: Renal stone disease has a high recurrence rate. Prompt metabolic evaluation followed by appropriate medical management is of paramount importance for preventing disease recurrence. Areas covered: A PubMed/Medline search was performed to identify randomized controlled studies evaluating medical treatments against renal stone recurrence. Due to the limited number of published randomized studies, non-randomized studies of significant importance were included and reported. Expert opinion: Thiazides are widely used for lowering calcium levels in urine and thus preventing calcium stone formation. Citrate supplements may increase the urine citrate level and increase pH. Allopurinol has shown significant efficacy for preventing formation of calcium stones in hyperuricosuric patients. Prevention of recurrence of infection stones and cystine stones has not been widely studied. Several agents that are used today have shown efficacy outside randomized controlled studies. However, they may produce severe adverse events, which are minimizing their use.

Clinical and Pathological Parameters Predicting Extracapsular Disease in Patients Undergoing a Radical Prostatectomy for Clinically Localized Prostate Cancer

To determine the epidemiological, clinical and pathological factors that can potentially predict extracapsular extension of prostate cancer in patients undergoing radical prostatectomy for clinically localized disease. We retrospectively analyzed the medical records of patients who undergone radical prostatectomy from January 2001 until November 2010. Patients age, prostate volume, PSA, PSA density, percent of cancer in prostate biopsy material, presence of cancer in biopsy cores of the right lobe or the left lobe or both lobes, Gleason summary, 1st Gleason pattern and 2nd Gleason pattern were analyzed for their predictive ability. From 187 studied patients, 44 of them (23.5%) had extracapsular disease. Multivariate analyses revealed that smaller prostate volumes and the presence of malignancy in both lobes after prostate biopsy were significant predictors for non-organ confined disease in the total population and in patients with Gleason score ≥ 7. Presence of malignancy in both lobes was the only significant predictive factor in patients with PSA ≤ 10 and in those with Gleason score ≤ 6. Prostate volume and positive cores for malignancy from both lobes after prostate biopsy are preoperative data that can be used for prediction of extracapsular disease. This information can be valuable in cases a nerve sparing radical prostatectomy is planned.

External validation of Resorlu–Unsal stone score as predictor of outcomes after retrograde intrarenal surgery

PurposeTo externally validate Resorlu–Unsal stone score (RUSS) and to evaluate its predictive accuracy.MethodsData of patients who underwent retrograde intrarenal surgery (RIRS) between October 2013 and June 2015 were collected. RUSS was applied to all patients, and the nomogram was externally validated. Area under the curve (AUC) was used for clinical validity assessment.ResultsA total of 85 patients were included in the study. Mean patient age was 54.3xa0±xa016.5, and mean stone size was 12.0xa0±xa06.21xa0mm. After applying RUSS, 56.5, 28.2, 9.41, and 5.88xa0% had score 0, 1, 2, and 3, respectively. RUSS was significantly associated with stone location and size. Postoperative stone-free rate was 74.1xa0%. Postoperative outcomes were significantly associated with RUSS and stone size. RUSS was found to be the only significant independent predictor in multivariate analysis, while it provided high predictive accuracy with an estimated AUC of 0.707.ConclusionsRUSS is a simple scoring system that may predict postoperative stone-free rate after RIRS with great efficacy and accuracy.

History of Ureteral Stenting Negatively Affects the Outcomes of Extracorporeal Shockwave Lithotripsy. Results of a Matched-pair Analysis

To evaluate the impact of ureteral stenting history to the outcomes of extracorporeal shockwave lithotripsy, we retrospectively analysed patients who underwent shockwave lithotripsy with Dornier Gemini lithotripter between September 2010 and August 2012. Forty seven patients (group A) who had a double J stent which was removed just before the procedure were matched-paired with another 47 patients (group B) who underwent shockwave lithotripsy having no stent history. The correlation between ureteral stenting history and stone-free rates was assessed. Stone-free rates were 68.1% and 87.2% for patients of group A and B, respectively (p=0.026). Postoperative complications were not different between groups. Multivariate analysis revealed that stone size (p=0.007), stone location (p=0.044) and history of ureteral stenting (p=0.046) were independent predictors for stone clearance after shockwave lithotripsy. Ureteral stents adversely affect shockwave lithotripsy outcome, even if they are removed before the procedure. Stenting history should divert treatment plan towards intracorporeal lithotripsy.